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Contact Information

COUNTRYSIDE DERMATOLOGY AND LASER CENTER INC
2467 ENTERPRISE RD
SUITE A
CLEARWATER, FL33763-1724
 Phone: 727-791-1411
 Fax: 727-791-1419
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for COUNTRYSIDE DERMATOLOGY AND LASER CENTER INC

NPI Number 1194914978
LBN Legal business name COUNTRYSIDE DERMATOLOGY AND LASER CENTER INC
Authorized official SUSAN ROPER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/17/2007
Last updated 10/17/2007 - About 19 years ago
Identifiers
FL License # 46341
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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