Organization
JACKSONVILLE SKIN CANCER CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL EDWARD LUTZ M.D. (PRESIDENT)
(904) 737-0111
Entity
Organization
Contact information
Practice address
4465 BAYMEADOWS RD STE 5, JACKSONVILLE, FL 32217-4727
(904) 737-0111
(904) 737-4422
Mailing address
4465 BAYMEADOWS RD STE 5, JACKSONVILLE, FL 32217-4727
(904) 737-0111
(904) 737-4422
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42484
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/22/2008
Last updated
12/21/2012
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