Associated Dermatologist PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME68137 Issued in FL

Legal business name

ASSOCIATED DERMATOLOGIST PA

Practice address

155 N Nova Rd
Ormond Beach, FL 32174-5138

Phone

(386) 672-3111

NPI assigned

Sep 11, 2007

Last updated

Sep 25, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John C Long Jr., MDNPI 1356351043

Title

Owner

Phone

(386) 672-3111

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 2

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.

• John Charles Long Jr., MD

  • Dermatology Physician
  • Ormond Beach, FL
  • NPI 1356351043
  NPD (past) Authorized official
• Eunice Sarah Mowery, PA-C

  • Medical Physician Assistant
  • Melbourne, FL
  • NPI 1558554501
  NPD (past)

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190678400000",
    "number": "1861687071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 N NOVA RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745138",
            "telephone_number": "386-672-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 N NOVA RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745138",
            "telephone_number": "386-672-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED DERMATOLOGIST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2007-09-25",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-672-3111",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME68137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K0008",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "N6001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arun K Dhand MD PL
• Cecil E. Ashby III, D.C.
• Marie Georgette Ashby, D.C.
• Lance Dean Ashworth, D.O.
• Assisted Living Properties, Inc. (Brookdale Ormond Beach West)
• Asthma and Allergy Specialist LLC
• Aleksey Atlanov, AP
• Atlantic Cardiovascular & Thoracic Surgeons, LLC
• Atlantic Medical Partners, PL
• Atlantic Mobile Imaging Services

• Dermatology Physician in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; 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.