Organization
TIM IOANNIDES MD LLC
Active
Other names
Treasure Coast Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIM IOANNIDES MD (OWNER)
(772) 878-3376
Entity
Organization
Contact information
Practice address
140 SW CHAMBER CT, SUITE 200, PORT ST LUCIE, FL 34986-3414
(772) 878-3376
(772) 879-9970
Mailing address
140 SW CHAMBER CT, SUITE 200, PORT ST LUCIE, FL 34986-3414
(772) 878-3376
(772) 879-9970
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74907
BCBS GROUP #
FL
01
—
DA2154
RAILROAD MEDICARE
FL
Enumeration date
05/02/2006
Last updated
12/22/2011
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