Organization
COASTAL DERMATOLOGY PA
Active
Other names
Goyal Dermatology Inc
Organization subpart
No
Provider details
NPI number
Authorized official
SANJIVA GOYAL M.D. (PRESIDENT)
(904) 567-1050
Entity
Organization
Contact information
Practice address
2804 SAINT JOHNS BLUFF RD S, STE 109, JACKSONVILLE, FL 32246-3776
(904) 727-9123
(904) 855-4255
Mailing address
PO BOX 2878, PONTE VEDRA BEACH, FL 32004-2878
(904) 567-1050
(904) 567-1051
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35493Z
MEDICARE PROVIDER ID
FL
01
—
K3994
MEDICARE PTAN
FL
Enumeration date
10/18/2005
Last updated
05/08/2015
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