Organization
ROGER H STEWART MD PA
Active
Other names
DERMATOLOGIC LASER & SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE KARTIKIS DAVIS (BILLING MANAGER)
(954) 908-7534
Entity
Organization
Contact information
Practice address
6550 N FEDERAL HWY STE 320, FT LAUDERDALE, FL 33308-1400
(954) 491-0510
(954) 491-0562
Mailing address
6550 N FEDERAL HWY STE 320, FT LAUDERDALE, FL 33308-1400
(954) 491-0510
(954) 491-0562
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0023885
FL
291U00000X
Clinical Medical Laboratory
SU14600
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K0561
MEDICARE PTAN
—
Enumeration date
11/01/2006
Last updated
06/30/2021
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