Venice Dermatology Clinic PA

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

Legal business name

VENICE DERMATOLOGY CLINIC PA

Doing business as

Reviance Dermatology

Practice address

3171 Bobcat Village Center Rd
North Port, FL 34288-8974

Phone

(941) 484-2250

NPI assigned

Jan 10, 2019

Last updated

Jan 10, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

VENICE DERMATOLOGY CLINIC PAAs reported in NPPES

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

Authorized official

Name

Dr. Bruce Allen BoydNPI 1750491494

Title

M.D./Owner

Phone

(941) 484-2250

Specialties & licenses 1

Addresses

Other names 1

• Reviance Dermatology Doing business as

Part of

Venice Dermatology Clin

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Venice Dermatology Clinic PA

  • Dermatology Physician
  • Venice, FL
  • NPI 1003007840
  NPPES parent name

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.

• Bruce Allen Boyd, MD

  • Dermatology Physician
  • Venice, FL
  • NPI 1750491494
  NPD (past) Authorized official

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547078400000",
    "number": "1801369020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924520",
            "telephone_number": "941-484-2250",
            "fax_number": "941-484-9638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3171 BOBCAT VILLAGE CENTER RD",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342888974",
            "telephone_number": "941-484-2250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENICE DERMATOLOGY CLINIC PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VENICE DERMATOLOGY CLINIC PA",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-10",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "M.D./OWNER",
        "authorized_official_telephone_number": "941-484-2250",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reviance Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nilton Vargas Jr., RBT, CPR
• Giovanna Vasconcelos
• Hilary Lauren Vasher
• Heather Vazquez
• Rebecca Velt
• Natalie Jade Vilardi
• Nelsy Villalobos
• Vip Therapy LLC
• Vitaly Rehab Incorporated
• Linda Ann Vodopija, MS-CCC/SLP

• Dermatopathology Physician in North Port, FL
• Providers in North Port, FL by specialty
• Dermatopathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2019; 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.