Fort Myers Dermatopathology PA

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

Legal business name

FORT MYERS DERMATOPATHOLOGY PA

Practice address

8381 Riverwalk Park Blvd
Suite 202
Ft Myers, FL 33919

Phone

(239) 274-0005

Fax

(239) 274-8185

NPI assigned

Apr 25, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mazen Daoud, MDNPI 1316903560

Title

President

Phone

(239) 274-0005

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 8

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

• Mazen Daoud, MD

  • Dermatopathology Physician
  • Fort Myers, FL
  • NPI 1316903560
  Medicare reassignment Care Compare group NPD Authorized official
• Enid B Martinez, PA

  • Physician Assistant
  • Fort Myers, FL
  • NPI 1992007280
  Medicare reassignment Care Compare group
• Janet Flores Cheng, M.D.

  • Dermatology Physician
  • Cape Coral, FL
  • NPI 1275521478
  Medicare reassignment NPD
• Christal L Dimarco, PA

  • Physician Assistant
  • Fort Myers, FL
  • NPI 1316249444
  Medicare reassignment
• Steven C Bernstein, MD

  • MOHS-Micrographic Surgery Physician
  • Fort Myers, FL
  • NPI 1174763353
  NPD (past)
• Debra D Fett Desmond, M.D.

  • Dermatology Physician
  • Fort Myers, FL
  • NPI 1386686020
  NPD (past)
• Anna J. McCaughna, N.P.

  • Family Nurse Practitioner
  • Ft Myers, FL
  • NPI 1649248493
  NPD (past)
• Kristin Schmidt, PA

  • Physician Assistant
  • Fort Myers, FL
  • NPI 1104081967
  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013973320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8381 RIVERWALK PARK BLVD",
            "address_2": "SUITE 202",
            "city": "FT MYERS",
            "state": "FL",
            "postal_code": "33919",
            "telephone_number": "239-274-0005",
            "fax_number": "239-274-8185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8381 RIVERWALK PARK BLVD",
            "address_2": "SUITE 202",
            "city": "FT MYERS",
            "state": "FL",
            "postal_code": "33919",
            "telephone_number": "239-274-0005",
            "fax_number": "239-274-8185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MYERS DERMATOPATHOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAOUD",
        "authorized_official_first_name": "MAZEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-274-0005",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE STAYWELL",
            "identifier": "202599",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "06492",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "284777",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "202599",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Myers Children'S Surgery Center, LLC
• Fort Myers Chiropractic & Nutrition Center, Inc.
• Fort Myers Chiropractic Studio LLC
• Fort Myers Dental Arts
• Fort Myers Dermatopathology
• Fort Myers Endoscopy Center LLC
• Fort Myers Eye Associates PA
• Fort Myers Eye Center Inc
• Fort Myers Eye Surgery Center LLC
• Fort Myers Family Medicine LLC

• Dermatopathology Physician in Ft Myers, FL
• Providers in Ft Myers, FL by specialty
• Dermatopathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.