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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