NPIMap

Organization Active NPI

Bluewater Dermatology, P.L.L.C.

  • Dermatology Physician
  • Destin, FL
National Provider Identifier
1003684283
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BLUEWATER DERMATOLOGY, P.L.L.C.
Practice address
703 Jupiter St
Destin, FL 32541-1810
Phone
(850) 585-1308
NPI assigned
Dec 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Authorized official

Name
Dr. Layne Marc Fielder, MDNPI 1740472380
Title
Owner
Phone
(850) 585-1308

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

703 Jupiter St
Destin, FL 32541-1810

Mailing address

703 Jupiter St
Destin, FL 32541-1810
Phone (850) 585-1308

National Provider Directory

National Provider Directory

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1003684283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 JUPITER ST",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325411810",
            "telephone_number": "850-585-1308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 JUPITER ST",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325411810",
            "telephone_number": "850-585-1308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEWATER DERMATOLOGY, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-17",
        "status": "A",
        "authorized_official_last_name": "FIELDER",
        "authorized_official_first_name": "LAYNE",
        "authorized_official_middle_name": "MARC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-585-1308",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Destin, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.