NPIMap

Organization Active NPI

Gulfshore Dermatology, P.a.

  • Dermatology Physician
  • Fort Myers, FL
National Provider Identifier
1205353687
Registry record updated Aug 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
OS6359 Issued in FL
Legal business name
GULFSHORE DERMATOLOGY, P.A.
Practice address
15620 New Hampshire CT
Fort Myers, FL 33908-4168
Phone
(239) 415-0004
NPI assigned
Aug 25, 2017
Last updated
Aug 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2017

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

Authorized official

Name
Jeffrey Neal Martin, D.O.NPI 1083677926
Title
President / Physician
Phone
(239) 415-0004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X OS6359 FL Primary

Addresses

Primary practice location

15620 New Hampshire CT
Fort Myers, FL 33908-4168

Mailing address

PO Box 835
Trussville, AL 35173-0835
Phone (205) 746-7752

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503619200000",
    "number": "1205353687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 835",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351730835",
            "telephone_number": "205-746-7752",
            "fax_number": "205-836-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15620 NEW HAMPSHIRE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084168",
            "telephone_number": "239-415-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULFSHORE DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2017-08-25",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "NEAL",
        "authorized_official_title_or_position": "PRESIDENT / PHYSICIAN",
        "authorized_official_telephone_number": "239-415-0004",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS6359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2017; 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.