| NPI | 1538773775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT LEAVITT Owner 407-875-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207ND0900X Dermatology Dermatopathology | |
| 207NS0135X Dermatology Procedural Dermatology | |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2020-09-04 |