Island Coast Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

OS0006359 Issued in FL

Legal business name

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

Organization subpart

No

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

Addresses

Other identifiers 4

Other names 1

• Island Coast Dermatology, PA Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas (Tomas) Carrasquillo Jr., M.D.

  • Surgery Physician
  • Cape Coral, FL
  • NPI 1801899786
  NPD (past)
• Kiet A. Doan, DO.

  • Surgery Physician
  • Cape Coral, FL
  • NPI 1033117783
  NPD (past)
• Rhonda Renea Hendricks, APRN

  • Family Nurse Practitioner
  • Cape Coral, FL
  • NPI 1720403074
  NPD (past)
• Janet Margaret Lightner, APRN

  • Gerontology Nurse Practitioner
  • Fort Myers, FL
  • NPI 1154778470
  NPD (past)

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA'S RAILROAD MEDICARE #",
            "identifier": "P00295648",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "44584",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GROUP #",
            "identifier": "DE4849",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070012707",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Coast Dermatology, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Isis Home Health Care, Inc.
• Amirul Islam, M.D.
• Saiful Islam, M.D.
• Island Behavioral Health PLLC
• Island Coast Behavioral Health and Therapy LLC
• Island Coast Pediatrics
• Island Coast Primary Care Project, Inc.
• Island Coast Primary Care Project, Inc.
• Island Facial Plastic and ENT Surgery, PA
• Island Park Psychiatry LLC

• Dermatology Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Dermatology Physician in Florida

• 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.