Exquisite Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME109349 Issued in DE

Legal business name

EXQUISITE DERMATOLOGY LLC

Practice address

12315 Lake Underhill Rd
Orlando, FL 32828-4507

Phone

(407) 403-5620

Fax

(407) 412-5920

NPI assigned

Feb 3, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Louise M Clingman

Title

Office Manager

Phone

(407) 459-5213

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1053779223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12315 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284507",
            "telephone_number": "407-403-5620",
            "fax_number": "407-412-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12315 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284507",
            "telephone_number": "407-403-5620",
            "fax_number": "407-412-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXQUISITE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-03",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "CLINGMAN",
        "authorized_official_first_name": "LOUISE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "407-459-5213",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "DE",
            "license": "ME109349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; 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.