Organization
INTEGRATED DERMATOLOGY OF TIDEWATER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY D QUEEN (OWNER)
(514) 314-2000
Entity
Organization
Contact information
Practice address
885 KEMPSVILLE RD STE 309, NORFOLK, VA 23502-3800
(757) 461-1033
Mailing address
4700 EXCHANGE CT STE 110, BOCA RATON, FL 33431-4450
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
07/24/2013
Last updated
01/29/2019
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