Leavitt Medical Associates Of Florida INC
Dermatology in Plant City, FL. Organization (NPI-2).
NPI number1649560335
StatusActive
Last updated in NPPESNov 16, 2011
Details
- NPI
- 1649560335
- Entity type
- Organization (NPI-2)
- Legal business name
- Leavitt Medical Associates Of Florida INC
- Organization subpart
- Yes
- Enumeration date
- Apr 14, 2011
- Last updated
- Nov 16, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
| 207ND0101X | Dermatology, MOHS-Micrographic Surgery | – | – | |
| 2086S0122X | Surgery, Plastic and Reconstructive Surgery | – | – |
Other names
- Advacned Dermatology And Cosmetic Surgery (Doing Business As)
Practice location
2005 W Reynolds StPlant City, FL 33563-4743
Phone 813-752-6824 · Fax 407-875-0518
Mailing address
2600 Lake Lucien DrSuite 180
Maitland, FL 32751-7233
Phone 407-875-2080 · Fax 407-875-0518
Authorized official
Nefrita Logan
Provider Service Rep
4078752080
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