NPIMap

Organization Active NPI

Countryside Dermatology and Laser Center Inc

  • Dermatology Physician
  • Clearwater, FL
National Provider Identifier
1194914978
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
46341 Issued in FL
Legal business name
COUNTRYSIDE DERMATOLOGY AND LASER CENTER INC
Practice address
2467 Enterprise Rd
Suite a
Clearwater, FL 33763-1724
Phone
(727) 791-1411
Fax
(727) 791-1419
NPI assigned
Oct 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Dr. Susan S Roper, M.D.
Title
Owner
Phone
(727) 791-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 46341 FL Primary

Addresses

Primary practice location

2467 Enterprise Rd
Suite a
Clearwater, FL 33763-1724

Mailing address

2467 Enterprise Rd
Suite a
Clearwater, FL 33763-1724
Phone (727) 791-1411

National Provider Directory

National Provider Directory

Locations

2467 Enterprise Rd
Ste B
Clearwater, FL 33763

Practitioners & affiliated clinicians

Practitioners 1

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": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1194914978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2467 ENTERPRISE RD",
            "address_2": "SUITE A",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631724",
            "telephone_number": "727-791-1411",
            "fax_number": "727-791-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2467 ENTERPRISE RD",
            "address_2": "SUITE A",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631724",
            "telephone_number": "727-791-1411",
            "fax_number": "727-791-1419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE DERMATOLOGY AND LASER CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "ROPER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-791-1411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "46341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.