Organization
ACUTE DERMATOLOGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAU PAULINA VU (OWNER)
(239) 482-7546
Entity
Organization
Contact information
Practice address
9400 GLADIOLUS DR, SUITE 320, FORT MYERS, FL 33908-6699
(239) 482-7546
Mailing address
PO BOX 101295, CAPE CORAL, FL 33910-1295
(239) 482-7546
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
OS9425
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274238100
—
FL
01
—
AJ932
MEDICARE PTAN
FL
Enumeration date
04/08/2008
Last updated
06/27/2008
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