Provider Demographics
NPI:1881172906
Name:PARKLAND DERMATOLOGY AND COSMETIC SURGERY
Entity type:Organization
Organization Name:PARKLAND DERMATOLOGY AND COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:754-999-3376
Mailing Address - Street 1:4360 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3817
Mailing Address - Country:US
Mailing Address - Phone:754-999-3376
Mailing Address - Fax:833-279-7072
Practice Address - Street 1:4360 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3817
Practice Address - Country:US
Practice Address - Phone:754-999-3376
Practice Address - Fax:833-279-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty