Active NPI
Fort Myers Dermatopathology
- Procedural Dermatology Physician
- Bonita Springs, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Procedural Dermatology Physician
- Legal business name
- FORT MYERS DERMATOPATHOLOGY
- Practice address
- 9411 Fountain Medical Court
Suite 101
Bonita Springs, FL 34135 - Phone
- (239) 274-0005
- Fax
- (239) 278-4718
- NPI assigned
- May 14, 2007
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mazen Daoud, MD
- Title
- President
- Phone
- (239) 274-0005
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Procedural Dermatology Physician | 207NS0135X | Primary |
Addresses
Primary practice location
9411 Fountain Medical Court
Suite 101
Bonita Springs, FL 34135
Mailing address
8381 Riverwalk Park Blvd
Suite 202
Fort Myers, FL 33919-8760
Phone (239) 274-0005
National Provider Directory
National Provider Directory- Tax ID family
- Fort Myers Dermatopathology
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Procedural Dermatology Physician
- Fort Myers, FL
- NPI 1083829337
-
- Procedural Dermatology Physician
- Cape Coral, FL
- NPI 1215142567
-
- Procedural Dermatology Physician
- Estero, FL
- NPI 1366657629
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.
-
- Dermatopathology Physician
- Fort Myers, FL
- NPI 1316903560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1831304500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8381 RIVERWALK PARK BLVD",
"address_2": "SUITE 202",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339198760",
"telephone_number": "239-274-0005",
"fax_number": "239-278-4718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9411 FOUNTAIN MEDICAL COURT",
"address_2": "SUITE 101",
"city": "BONITA SPRINGS",
"state": "FL",
"postal_code": "34135",
"telephone_number": "239-274-0005",
"fax_number": "239-278-4718"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FORT MYERS DERMATOPATHOLOGY",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-14",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "DAOUD",
"authorized_official_first_name": "MAZEN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "239-274-0005",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207NS0135X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Procedural Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonita Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.