Ft. Lauderdale Dermatology & Cosmetic Center

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

FT. LAUDERDALE DERMATOLOGY & COSMETIC CENTER

Practice address

5721 NE 27TH Ave
Ft Lauderdale, FL 33308-2703

Phone

(954) 772-0416

NPI assigned

Oct 2, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jason Bradley Green, D.O.

Title

President/Owner

Phone

(954) 772-0416

Specialties & licenses 1

Addresses

Tax ID family

Aventura Dermatology Cosmetic Center PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Aventura Dermatology & Cosmetic Center, P.a.

  • Procedural Dermatology Physician
  • Fort Lauderdale, FL
  • NPI 1003003195
  NPD tax ID

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222905600000",
    "number": "1548411077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5721 NE 27TH AVE",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333082703",
            "telephone_number": "954-772-0416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5721 NE 27TH AVE",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333082703",
            "telephone_number": "954-772-0416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT. LAUDERDALE DERMATOLOGY & COSMETIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2008-10-02",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "954-772-0416",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ft. Lauderdale Family Chiropractic, P.a.
• FTL Massage LLC
• Yanelys Fuentes, PHARMD
• Ignacio Jose Fuertes
• Akilah Fuller, PHARMD, MS

• Dermatology Physician in Ft Lauderdale, FL
• Providers in Ft Lauderdale, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.