Organization
DIVINE DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROL JEANNE SIMS-ROBERTSON MD (OWNER PRACTITIONER)
(727) 528-0321
Entity
Organization
Contact information
Practice address
2100 DR MARTIN LUTHER KING JR ST N, ST PETERSBURG, FL 33704-3264
(727) 528-0321
(727) 498-8832
Mailing address
2100 DR MARTIN LUTHER KING JR ST N, ST PETERSBURG, FL 33704-3264
(727) 528-0321
(727) 498-8832
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME87149
FL
Other
Enumeration date
08/30/2006
Last updated
10/16/2009
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