Organization
FLORIDA DERMATOLOGY ASSOCIATES INC
Active
Organization
FLORIDA DERMATOLOGY ASSOCIATES INC
Active
Other names
Palm Bay Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUBEN MORENO MD (PRESIDENT)
(321) 768-1600
Entity
Organization
Contact information
Practice address
5070 MINTON RD NW, SUITE 5, PALM BAY, FL 32907-1157
(321) 768-1600
(321) 768-6418
Mailing address
5070 MINTON RD NW, SUITE 3A, PALM BAY, FL 32907-1157
(321) 768-1600
(321) 799-4903
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
ME51282
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070002166A
RAILROAD MEDICARE
FL
01
—
169940
WELLCARE
FL
01
—
94928
BCBS
FL
Enumeration date
04/14/2006
Last updated
11/10/2023
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