NPIMap

Organization Active NPI

Space Coast Dermatology Clinic, PLLC

  • Clinic/Center
  • Merritt Island, FL
National Provider Identifier
1043423189
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SPACE COAST DERMATOLOGY CLINIC, PLLC
Practice address
695 Cone Park CT
Merritt Island, FL 32952-3755
Phone
(321) 453-3360
Fax
(321) 453-4586
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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

Authorized official

Name
Dr. James A Earhart, M.D.
Title
Partner
Phone
(321) 453-3360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

695 Cone Park CT
Merritt Island, FL 32952-3755

Mailing address

695 Cone Park CT
Merritt Island, FL 32952-3755
Phone (321) 453-3360

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1043423189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 CONE PARK CT",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329523755",
            "telephone_number": "321-453-3360",
            "fax_number": "321-453-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 CONE PARK CT",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329523755",
            "telephone_number": "321-453-3360",
            "fax_number": "321-453-4586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST DERMATOLOGY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "EARHART",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "321-453-3360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.