Organization
SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA
Active
Organization
SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RALPH EUGENE MASSULLO JR. MD (PRESIDENT)
(352) 746-2200
Entity
Organization
Contact information
Practice address
525 N DACIE PT, LECANTO, FL 34461-8399
(352) 746-2200
(352) 746-9320
Mailing address
525 N DACIE PT, LECANTO, FL 34461-8399
(352) 746-2200
(352) 746-9320
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377238100
—
FL
01
—
CA6816
SRRGA
FL
Enumeration date
09/01/2005
Last updated
11/15/2011
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