Orlando Skin Institute, LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

OS4781 Issued in FL

Legal business name

ORLANDO SKIN INSTITUTE, LLC

Practice address

110 Pond CT
Ste 301
Debary, FL 32713

Phone

(386) 742-0419

Fax

(386) 742-4119

NPI assigned

Jun 22, 2015

Organization subpart

No

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

Authorized official

Name

Gary Waterman, DO

Title

Owner

Phone

(386) 742-0419

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1215319793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 POND CT",
            "address_2": "STE 301",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "32713",
            "telephone_number": "386-742-0419",
            "fax_number": "386-742-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 POND CT",
            "address_2": "STE 301",
            "city": "DEBARY",
            "state": "FL",
            "postal_code": "32713",
            "telephone_number": "386-742-0419",
            "fax_number": "386-742-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLANDO SKIN INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-22",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "WATERMAN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-742-0419",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "OS4781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Rohan Ogle, MD
• Ohana Health P.a.
• Judy A Oldham, FOSTER PARENT
• Kellie Oliver, ARNP
• Orlando Family Physicians, LLC
• Osborn Wellness and Counseling
• Amanda Beth Ostrowski, M.S. CCC-SLP
• Christopher Joel Pagan Albelo, DC
• Chassidy Palma
• Kristyna D Paradis, DO

• All providers in Debary, FL
• Procedural Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.