Advanced Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME63182 Issued in FL

Legal business name

ADVANCED DERMATOLOGY, PA

Practice address

1361 13TH Ave S
Suite 180
Jacksonville Beach, FL 32250-3233

Phone

(904) 247-4300

Fax

(904) 247-4350

NPI assigned

Feb 13, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Christine NG, M.D.

Title

President

Phone

(904) 247-4300

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1295903276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S",
            "address_2": "SUITE 180",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503233",
            "telephone_number": "904-247-4300",
            "fax_number": "904-247-4350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S",
            "address_2": "SUITE 180",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503233",
            "telephone_number": "904-247-4300",
            "fax_number": "904-247-4350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "NG",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-247-4300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME63182",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "ME63182",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.