Organization
INTEGRATED DERMATOLOGY OF TAMPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY QUEEN (MANAGER)
(561) 314-2000
Entity
Organization
Contact information
Practice address
15310 AMBERLY DR, SUITE 150, TAMPA, FL 33647-2199
(813) 978-8888
(813) 972-8974
Mailing address
902 CLINT MOORE RD, SUITE 226, BOCA RATON, FL 33487-2800
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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