Organization
CLEARWATER DERMATOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER STEVEN GOLOMB MD (PRESIDENT)
(727) 461-2282
Entity
Organization
Contact information
Practice address
1122 DRUID RD E, CLEARWATER, FL 33756-4100
(727) 461-2282
Mailing address
1122 DRUID RD E, CLEARWATER, FL 33756-4100
(727) 461-2282
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0021279
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004563725
AETNA PROV CLWR DERM
FL
01
—
0300627
UHC GROUP # CLWR DERM
FL
05
—
250114700
—
FL
Enumeration date
02/21/2006
Last updated
12/30/2013
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