Organization
SUNSHINE STATE DERMATOLOGY AND SKIN CANCER CENTER INC
Active
Other names
Sunshine State Dermatology and Skin Cancer Center Inc, Sunshine State Dermatology and Skin Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADAM S GREENBERG MD (PRESIDENT)
(941) 282-3376
Entity
Organization
Contact information
Practice address
12497 TAMIAMI TRL S, UNIT 1, NORTH PORT, FL 34287-1415
(941) 282-3376
(941) 282-3378
Mailing address
88 SUGAR MILL DR, OSPREY, FL 34229-9077
(941) 228-9183
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932193729
NPI
—
01
—
YCEA9
BCBS PAYER ID
FL
Enumeration date
03/07/2023
Last updated
07/31/2024
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