Organization
PROFESSIONAL DERMATOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND R KNISLEY DO (OWNER)
(940) 867-6030
Entity
Organization
Contact information
Practice address
217 E CENTRAL AVE, WINTER HAVEN, FL 33880-6312
(315) 363-7407
Mailing address
4336 DUCK DOWN LN, WINTER HAVEN, FL 33884-3293
(940) 867-6030
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
01/01/2024
Last updated
01/01/2024
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