Dermatology Associates of Bay County

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

800025570 Issued in FL

Legal business name

DERMATOLOGY ASSOCIATES OF BAY COUNTY

Doing business as

Pathology Services of America Division of Dermatology Associates of Ba

Practice address

2430 Lisenby Ave
Panama City, FL 32405

Phone

(850) 215-0953

Fax

(850) 215-0952

NPI assigned

Nov 2, 2009

Last updated

Nov 9, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

DERMATOLOGY ASSOCIATES OF BAY COUNTYAs reported in NPPES

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

Authorized official

Name

Mr. Kenneth Warren Alexander, HTL(ASCP)

Title

Laboratory Manager

Phone

(850) 215-0953

Specialties & licenses 1

Addresses

Other names 1

• Pathology Services of America Division of Dermatology Associates of Ba Doing business as

Part of

Dermatology Associates

Locations

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257724800000",
    "number": "1831425420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 LISENBY AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324053585",
            "telephone_number": "850-215-0953",
            "fax_number": "850-215-0952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 LISENBY AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "32405",
            "telephone_number": "850-215-0953",
            "fax_number": "850-215-0952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF BAY COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DERMATOLOGY ASSOCIATES OF BAY COUNTY",
        "enumeration_date": "2009-11-02",
        "last_updated": "2009-11-09",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "LABORATORY MANAGER",
        "authorized_official_telephone_number": "850-215-0953",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "HTL(ASCP)"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "800025570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pathology Services of America Division of Dermatology Associates of Ba",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marla Gail Denecke, ARNP
• Forrest Ed Dennis, LMHC
• Wesley Addison Dent, DMD
• William W Dent, MD
• Dermatology and Mohs Surgery Center LLC
• Dermatology Associates of Bay County, P.a.
• Cyril Chitta Desilva, M.D.
• Anita B. Desonia, MS, LMHC
• Emma Renee Devine, RBT
• McKenna Paige Devlin, PA-C

• MOHS-Micrographic Surgery Physician in Panama City, FL
• Providers in Panama City, FL by specialty
• MOHS-Micrographic Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; 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.