NPIMap

Organization Active NPI

Dermatology Associates of Bay County, P.a.

  • Dermatology Physician
  • Marianna, FL
National Provider Identifier
1437444817
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY ASSOCIATES OF BAY COUNTY, P.A.
Practice address
3025 6TH St
Marianna, FL 32446-1930
Phone
(850) 769-1668
Fax
(850) 785-2123
NPI assigned
Jun 14, 2011
Last updated
Jun 16, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
DERMATOLOGY ASSOCIATES OF BAY COUNTY. P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

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

Authorized official

Name
Dr. Robert John Siragusa, MDNPI 1255320545
Title
President
Phone
(850) 769-1668

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU

Addresses

Primary practice location

3025 6TH St
Marianna, FL 32446-1930

Mailing address

1900 Harrison Ave
Panama City, FL 32405-4542
Phone (850) 769-1668

Other identifiers 2

IdentifierTypeStateIssuer
99500OtherBCBS OF FL
000164600MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Dermatology Assoc of Ba4 organizations share this tax ID, including this one
Part of
Dermatology Assoc of Ba

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3025 6th St
Marianna, FL 32446
Phone (850) 526-3434

Practitioners & affiliated clinicians

Practitioners 1

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": "1308009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1437444817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 HARRISON AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054542",
            "telephone_number": "850-769-1668",
            "fax_number": "850-785-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 6TH ST",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324461930",
            "telephone_number": "850-769-1668",
            "fax_number": "850-785-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF BAY COUNTY, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DERMATOLOGY ASSOCIATES OF BAY COUNTY. P.A.",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "SIRAGUSA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-769-1668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "99500",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000164600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marianna, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; 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.