Provider Demographics
NPI:1871599365
Name:OCALA DERMATOLOGY & SKIN CANCER CENTER, P.A.
Entity type:Organization
Organization Name:OCALA DERMATOLOGY & SKIN CANCER CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-237-2322
Mailing Address - Street 1:3233 SW 33RD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8468
Mailing Address - Country:US
Mailing Address - Phone:352-237-2322
Mailing Address - Fax:352-237-2456
Practice Address - Street 1:3233 SW 33RD RD
Practice Address - Street 2:STE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8468
Practice Address - Country:US
Practice Address - Phone:352-237-2322
Practice Address - Fax:352-237-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40485207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME155877OtherFLORIDA MEDICAL LICENSE
FLME155877OtherFLORIDA MEDICAL LICENSE