NPIMap

Organization Active NPI

Gary L Stevensmdpa

Doing business as Central Florida Dermatology skin Cancer Center

  • MOHS-Micrographic Surgery Physician
  • Winter Haven, FL
National Provider Identifier
1083825491
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
ME75661 Issued in FL
Legal business name
GARY L STEVENSMDPA
Doing business as
Central Florida Dermatology skin Cancer Center
Practice address
475 E Central Ave
Winter Haven, FL 33880-3051
Phone
(863) 293-2147
Fax
(863) 294-2767
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Authorized official

Name
Dr. Gary L Stevens, MD
Title
President
Phone
(863) 293-2147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X ME75661 FL Primary

Addresses

Primary practice location

475 E Central Ave
Winter Haven, FL 33880-3051

Mailing address

475 E Central Ave
Winter Haven, FL 33880-3051
Phone (863) 293-2147

Other names 1

  • Central Florida Dermatology skin Cancer Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1083825491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 E CENTRAL AVE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803051",
            "telephone_number": "863-293-2147",
            "fax_number": "863-294-2767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 E CENTRAL AVE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803051",
            "telephone_number": "863-293-2147",
            "fax_number": "863-294-2767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY L STEVENSMDPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-293-2147",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME75661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Florida Dermatology skin Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.