Provider Demographics
NPI:1427141332
Name:FLORIDA SKIN CANCER & DERMATOLOGY SPECIALISTS, PA
Entity type:Organization
Organization Name:FLORIDA SKIN CANCER & DERMATOLOGY SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-7546
Mailing Address - Street 1:PO BOX 357730
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7730
Mailing Address - Country:US
Mailing Address - Phone:352-371-7546
Mailing Address - Fax:352-335-7546
Practice Address - Street 1:3700 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-371-7546
Practice Address - Fax:352-335-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59336207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC1427OtherRAILROAD MEDICARE GROUP #
FLP00057075OtherRAILROAD MEDICARE PIN
FLK4800Medicare ID - Type Unspecified
FLP00343361Medicare PIN
FLQ00662Medicare UPIN
FLP00196563Medicare PIN
FLU1568ZMedicare PIN
FLAF035ZMedicare PIN
FLP00057075OtherRAILROAD MEDICARE PIN
FLS69734Medicare UPIN
FLG43816Medicare UPIN
FL68814YMedicare PIN