Florida Center for Dermatology, P.a.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME92201 Issued in FL

Legal business name

FLORIDA CENTER FOR DERMATOLOGY, P.A.

Practice address

105 Southpark Blvd
Suite A103
St Augustine, FL 32086-5191

Phone

(904) 342-7765

Fax

(904) 342-7770

NPI assigned

Apr 11, 2012

Last updated

Apr 11, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Kantor, M.D.NPI 1326038886

Title

President

Phone

(904) 342-7765

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathan Kantor, MD

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1326038886

  FL

  Medicare reassignment NPD Authorized official
• Zachary Bouchelle

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1598205122
  Medicare reassignment
• Alejandro Navarro, PA-C

  • Medical Physician Assistant
  • St Augustine, FL
  • NPI 1962719492
  Medicare reassignment
• Nicole Aileen Ortlieb

  • Physician Assistant
  • Fernandina Beach, FL
  • NPI 1801663539
  Medicare reassignment
• Maxwell Clark Poling, PA-C

  • Physician Assistant
  • Indialantic, FL
  • NPI 1871039727
  Medicare reassignment
• Ralph David Priddy, PA-C

  • Physician Assistant
  • St Augustine, FL
  • NPI 1497021059
  Medicare reassignment

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

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334102400000",
    "number": "1073870341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SOUTHPARK BLVD",
            "address_2": "SUITE A103",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865191",
            "telephone_number": "904-342-7765",
            "fax_number": "904-342-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SOUTHPARK BLVD",
            "address_2": "SUITE A103",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865191",
            "telephone_number": "904-342-7765",
            "fax_number": "904-342-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA CENTER FOR DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-11",
        "last_updated": "2012-04-11",
        "status": "A",
        "authorized_official_last_name": "KANTOR",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-342-7765",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME92201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Flagler Psychiatric Associates
• Katherine Daly Flechaus, LCSW
• Julie Lynn Flick, M.D.
• Flo Yoga Spa
• Florida Autism Center
• Florida Center for TMS
• Florida Department of Health (St Johns County Health Department)
• Florida Department of Veterans Affairs (Clyde E Lassen State Veterans Nursing Home)
• Florida Department of Veterans' Affairs (Clyde E. Lassen State Veterans' Nursing Home)
• Florida Em-I Medical Services PA

• Dermatology Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; 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.