Favreau Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

OS9004 Issued in FL

Legal business name

FAVREAU DERMATOLOGY LLC

Practice address

201 SE 14TH St
Fort Lauderdale, FL 33316-1827

Phone

(954) 457-4201

NPI assigned

May 11, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Mo Toledo

Title

Authorized Official

Phone

(954) 457-4201

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1982130985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SE 14TH ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161827",
            "telephone_number": "954-457-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SE 14TH ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161827",
            "telephone_number": "954-457-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAVREAU DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "TOLEDO",
        "authorized_official_first_name": "MO",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "954-457-4201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS9004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.