NPIMap

Organization Active NPI

Creekside Dermatology PA

  • Dermatology Physician
  • The Villages, FL
National Provider Identifier
1740703818
Registry record updated Jul 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
108772 Issued in FL
Legal business name
CREEKSIDE DERMATOLOGY PA
Practice address
8630 E County Road 466 Ste a
The Villages, FL 32162-5614
Phone
(352) 399-7295
Fax
(352) 399-7294
NPI assigned
Jul 20, 2017
Last updated
Jul 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2017

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

Authorized official

Name
Dr. David Casper, MDNPI 1164614004
Title
President
Phone
(352) 399-7295

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 Physician 207N00000X 108772 FL Primary

Addresses

Primary practice location

8630 E County Road 466 Ste a
The Villages, FL 32162-5614

Mailing address

8620 E County Road 466
The Villages, FL 32162-3670
Phone (352) 399-7295

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

8630 E County Road 466
Ste A
The Villages, FL 32162
Phone (352) 399-7295

Practitioners & affiliated clinicians

Practitioners 12

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": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500508800000",
    "number": "1740703818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8620 E COUNTY ROAD 466",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321623670",
            "telephone_number": "352-399-7295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8630 E COUNTY ROAD 466 STE A",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321625614",
            "telephone_number": "352-399-7295",
            "fax_number": "352-399-7294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-20",
        "last_updated": "2017-07-20",
        "status": "A",
        "authorized_official_last_name": "CASPER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-399-7295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "108772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in The Villages, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2017; 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.