Organization
COUNTRYSIDE DERMATOLOGY AND LASER CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN S ROPER M.D. (OWNER)
(727) 791-1411
Entity
Organization
Contact information
Practice address
2467 ENTERPRISE RD, SUITE A, CLEARWATER, FL 33763-1724
(727) 791-1411
(727) 791-1419
Mailing address
2467 ENTERPRISE RD, SUITE A, CLEARWATER, FL 33763-1724
(727) 791-1411
(727) 791-1419
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
46341
FL
Other
Enumeration date
10/17/2007
Last updated
10/17/2007
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