NPIMap

Organization Active NPI

Boca Grande Dermatology PLLC

  • Dermatology Physician
  • Boca Grande, FL
National Provider Identifier
1063836773
Registry record updated Dec 9, 2014
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Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME116621 Issued in FL
Legal business name
BOCA GRANDE DERMATOLOGY PLLC
Practice address
320 Park Avenue
Boca Grande, FL 33921
Phone
(941) 964-0490
NPI assigned
Feb 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Authorized official

Name
Dr. Timothy J Corey, M. D.
Title
Manager
Phone
(941) 855-9372

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X ME116621 FL Primary

Addresses

Primary practice location

320 Park Avenue
Boca Grande, FL 33921

Mailing address

PO Box 1883
415 Rock Dove Dr
Boca Grande, FL 33921-1883
Phone (941) 855-9372

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1392595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1063836773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1883",
            "address_2": "415 ROCK DOVE DR",
            "city": "BOCA GRANDE",
            "state": "FL",
            "postal_code": "339211883",
            "telephone_number": "941-855-9372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 PARK AVENUE",
            "city": "BOCA GRANDE",
            "state": "FL",
            "postal_code": "33921",
            "telephone_number": "941-964-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOCA GRANDE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-17",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "COREY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "941-855-9372",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME116621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Grande, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.