NPIMap

Organization Active NPI

Ft. Lauderdale Dermatology & Cosmetic Center

  • Dermatology Physician
  • Fort Lauderdale, FL
National Provider Identifier
1548411077
Registry record updated Oct 2, 2008
On this page

Key facts

NPPES NPI Registry
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
Last updated
Oct 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2008

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.NPI 1427167261
Title
President/Owner
Phone
(954) 772-0416

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 1

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

Addresses

Primary practice location

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

Mailing address

5721 NE 27TH Ave
Ft Lauderdale, FL 33308-2703
Phone (954) 772-0416

National Provider Directory

National Provider Directory
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.

Locations

5721 NE 27th Ave
Ft Lauderdale, FL 33308
Phone (954) 772-0416

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": "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": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • 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.