Organization
FT. LAUDERDALE DERMATOLOGY & COSMETIC CENTER
Active
Organization
FT. LAUDERDALE DERMATOLOGY & COSMETIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON BRADLEY GREEN D.O. (PRESIDENT/OWNER)
(954) 772-0416
Entity
Organization
Contact information
Practice address
5721 NE 27TH AVE, FT LAUDERDALE, FL 33308-2703
(954) 772-0416
Mailing address
5721 NE 27TH AVE, FT LAUDERDALE, FL 33308-2703
(954) 772-0416
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
10/02/2008
Last updated
10/02/2008
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