Organization
COAST DERMATOLOGY AND SKIN CANCER CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GREGORY NEILY D.O. (PHYSCIAN)
(941) 493-7400
Entity
Organization
Contact information
Practice address
21550 ANGELA LN, VENICE, FL 34293-2017
(941) 493-7400
(941) 493-1940
Mailing address
21550 ANGELA LN, VENICE, FL 34293-2017
(941) 493-7400
(941) 493-1940
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OS0006785
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99100
BLUE SHIELD GROUP NUMBER
FL
Enumeration date
03/20/2007
Last updated
05/22/2009
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