| NPI | 1730391061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN HOLLOWAY WEINKLE Owner 941-794-5432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL 45450) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 45450) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL 45450) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2011-06-02 |