Organization
FLORIDA DERMATOLOGY AND SKIN CANCER SPECIALISTS PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A SCANNON MD (PRESIDENT)
(813) 877-4811
Entity
Organization
Contact information
Practice address
870 77TH AVE N STE 1, ST PETERSBURG, FL 33702-5240
(727) 821-3600
(727) 821-3611
Mailing address
870 77TH AVE N STE 1, ST PETERSBURG, FL 33702-5240
(727) 821-3600
(727) 821-3611
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D1075937
CLIA
—
01
—
DT3661
RAILROAD MEDICARE
—
Enumeration date
08/02/2012
Last updated
05/17/2024
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