Organization
BLUEWATER DERMATOLOGY AND SKIN CANCER CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J BRAZA MD (PRESIDENT)
(910) 640-0899
Entity
Organization
Contact information
Practice address
144 POOLE RD STE 101, LELAND, NC 28451-9504
(910) 262-1048
(910) 256-6039
Mailing address
144 POOLE RD STE 101, LELAND, NC 28451-9504
(910) 262-1048
(910) 256-6039
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
2012-00516
NC
Other
Enumeration date
06/28/2017
Last updated
11/01/2021
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