Organization
INTEGRATED DERMATOLOGY OF GRANVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY D. QUEEN (OWNER)
(561) 314-2000
Entity
Organization
Contact information
Practice address
1959 NEWARK GRANVILLE RD, GRANVILLE, OH 43023-9171
(740) 587-0778
(740) 587-0601
Mailing address
4700 EXCHANGE CT STE 110, BOCA RATON, FL 33431-4450
(561) 314-2000
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
10/23/2013
Last updated
01/18/2019
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