Organization
FLORIDA CENTER FOR DERMATOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN KANTOR M.D. (PRESIDENT)
(904) 342-7765
Entity
Organization
Contact information
Practice address
105 SOUTHPARK BLVD, SUITE A103, ST AUGUSTINE, FL 32086-5191
(904) 342-7765
(904) 342-7770
Mailing address
105 SOUTHPARK BLVD, SUITE A103, ST AUGUSTINE, FL 32086-5191
(904) 342-7765
(904) 342-7770
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME92201
FL
Other
Enumeration date
04/11/2012
Last updated
04/11/2012
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