NPIMap

Organization Active NPI

Island Coast Dermatology, PA

  • Dermatology Physician
  • Fort Myers, FL
National Provider Identifier
1295886539
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
OS0006359 Issued in FL
Legal business name
ISLAND COAST DERMATOLOGY, PA
Doing business as
Island Coast Dermatology, PA
Practice address
7310 College Pkwy
Fort Myers, FL 33907-5503
Phone
(239) 768-6100
Fax
(239) 561-3763
NPI assigned
Jan 15, 2007
Last updated
Jun 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Authorized official

Name
Dr. Jeffrey N Martin, D.O.
Title
Sole Proprietor
Phone
(239) 768-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X OS0006359 FL Primary

Addresses

Primary practice location

7310 College Pkwy
Fort Myers, FL 33907-5503

Mailing address

7310 College Pkwy
Fort Myers, FL 33907-5503
Phone (239) 768-6100

Other names 1

  • Island Coast Dermatology, PA Doing business as

National Provider Directory

National Provider Directory

Locations

708 Del Prado Blvd S
Ste 1
Cape Coral, FL 33990
Phone (239) 424-3120

Practitioners & affiliated clinicians

Practitioners 4

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": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1295886539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 COLLEGE PKWY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075503",
            "telephone_number": "239-768-6100",
            "fax_number": "239-561-3763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 COLLEGE PKWY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075503",
            "telephone_number": "239-768-6100",
            "fax_number": "239-561-3763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND COAST DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "239-768-6100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS0006359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Coast Dermatology, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 24, 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.