| NPI | 1609975374 |
|---|---|
| Doing Business As | ATLANTIC BOULEVARD DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | JOHN MORELLO President 904-221-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME63627) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME63627) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: FL ME63627) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL ME63627) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME63627) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-03-07 |