Organization
MYERS & FOTOPOULOS MDS PA
Active
Other names
NEW IMAGE DERMATOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE FOTOPOULOS M.D. (PRESIDENT)
(727) 847-3992
Entity
Organization
Contact information
Practice address
5534 GULF DR, STE 1, NEW PORT RICHEY, FL 34652-4000
(727) 847-3992
(727) 848-1118
Mailing address
5534 GULF DR, STE 1, NEW PORT RICHEY, FL 34652-4000
(727) 847-3992
(727) 848-1118
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34711
BLUE CROSS BLUE SHIELD
FL
01
—
8550571-00
CIGNA
FL
01
—
CC5751
RAILROAD MEDICARE
FL
Enumeration date
10/14/2005
Last updated
01/30/2014
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