Mobilederm, Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MOBILEDERM, INC.

Practice address

3200 S University Dr
Davie, FL 33328-2018

Phone

(954) 970-5824

NPI assigned

Aug 27, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Declue

Title

Director, Provider Services

Phone

(407) 875-2080

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221004800000",
    "number": "1003063405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19230 NE 20TH CT",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331794369",
            "telephone_number": "954-970-5824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-970-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILEDERM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER SERVICES",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Mirza
• Violeta Mitchell
• Mizell Palliative Care Center
• Mobile Medical Scanner LLC
• Mobile Practitioner Services to You Inc
• Moblie Diagnostic Imaging Inc.
• Rachel L Modell
• Pinkal Modi
• Saudah Mohamed
• Aliya Mohammed

• Dermatology Physician in Davie, FL
• Providers in Davie, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.