SOUTHEASTERN DERMATOLOGY GROUP PA (NPI# 1518972231) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518972231 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN DERMATOLOGY GROUP PA |
| Other Organization Name | GULF COAST DERMATOLOGY |
| Practice Address |
2505 Harrison Ave Panama City FL 32405-4423 |
| Practice Telephone | 8502333376 |
| Practice Fax Number | 8505228354 |
| Mailing Telephone | 8502333376 |
| Mailing Fax Number | 8505228354 |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2017-11-10 |
| Authorized Official Name | JON WARD (PRESIDENT) |
| Authorized Official Telephone | 8502333376 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 95816 | FL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Gulf Coast Dermatology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871087882 | Southeastern Dermatology Group Pa | Pharmacy | 2505 Harrison Ave Ste A, Panama City, FL 32405 | 2018-06-22 |
| Street Address |
2505 HARRISON AVE |
| City | PANAMA CITY |
| State | FL |
| Zip Code | 32405-4423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164403390 | Angela Marie Danley | Physician Assistant | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2005-11-05 |
| 1437422342 | Karrie A Burkhardt | Physician Assistant | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2012-02-23 |
| 1194956524 | Kristi Byers Wells | Physician Assistant | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2009-08-03 |
| 1669504056 | Heather Lynn Preisser | Physician Assistant | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2007-03-12 |
| 1396883989 | Barry Edward Newton | Physician Assistant | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2007-02-03 |
| 1043370240 | Tricia Elizabeth Berry | Nurse Practitioner | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2006-12-11 |
| 1720039829 | Jon Ward | Dermatology | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2006-05-13 |
| 1407835184 | Michael B Morgan | Pathology | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2006-01-11 |
| 1548246903 | Amy Sue West | Physician Assistant | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2005-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457962136 | Kimberlea Fox | Behavioral Analyst | 4750 Collegiate Drive, Technology Building 157, Panama City, FL 32405 | 2020-08-14 |
| 1598325714 | Covenant Home Health Care, LLC | Home Health | 107 W. 19th Street, Panama City, FL 32405 | 2019-06-19 |
| 1467921403 | Amy Hancock | Counselor | 1212 W. 19th St., Panama City, FL 32405 | 2018-11-20 |
| 1063991917 | Patricia Kagendo Mutunga | Day Training, Developmentally Disabled Services | 2813 Fairmont Dr, Panama City, FL 32405 | 2018-08-11 |
| 1871087882 | Southeastern Dermatology Group Pa | Pharmacy | 2505 Harrison Ave Ste A, Panama City, FL 32405 | 2018-06-22 |
| 1346733615 | Jessica Nicole Graham | Nurse Practitioner | 2507 Harrison Ave Unit 101, Panama City, FL 32405 | 2018-06-12 |
| 1437658424 | Coastal Mobility Transportation, LLC | Non-emergency Medical Transport (VAN) | 203 Forest Park Circle, Panama City, FL 32405 | 2018-02-06 |
| 1003314915 | The Anti-aging Clinic of Northwest Florida | Obstetrics & Gynecology | 3019 Osprey Cir, Panama City, FL 32405 | 2018-01-25 |
| 1255848487 | Sarah Theriot | Social Worker | 700 W 23rd St Bldg H, Panama City, FL 32405 | 2018-01-09 |
| 1336686054 | Angela Leake | Registered Nurse | 449 W 23 St, Panama City, FL 32405 | 2017-01-20 |
| Find all providers in zip 32405 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255320545 | Robert John Siragusa | Dermatology | 1900 Harrison Ave, Panama City, FL 32405-4542 | 2005-10-19 |
| 1720039829 | Jon Ward | Dermatology | 2505 Harrison Ave, Panama City, FL 32405-4423 | 2006-05-13 |
| 1215904404 | Dermatology Associates of Bay County, P.a. | Dermatology | 1900 Harrison Ave, Panama City, FL 32405-4542 | 2006-03-07 |
| 1811972391 | Charles Russell Kovaleski | Dermatology | 1900 Harrison Ave, Panama City, FL 32405-4542 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002154 | Precision Skin LLC | Dermatology | 3501 S University Dr Ste 5, Davie, FL 33328-2001 | 2020-10-28 |
| 1487252417 | Janice Reaume | Dermatology | 3335 Imperial Manor Way, Mulberry, FL 33860-5519 | 2020-10-12 |
| 1922617729 | Synergymd, LLC | Dermatology | 1208 E Kennedy Blvd Ste 221, Tampa, FL 33602-3509 | 2020-07-28 |
| 1518585447 | Alexander F Wong | Dermatology | 1300 Goodlette-frank Rd N, Naples, FL 34102-5243 | 2020-07-07 |
| 1508495003 | Elite Dermatology | Dermatology | 401 Coral Way Ste 207, Coral Gables, FL 33134-4924 | 2020-04-06 |
| 1124668371 | Meaghan Margaret Birakis | Dermatology | 3319 Fl-7 #202, Wellington, FL 33449 | 2020-01-15 |
| 1396380044 | Suzanne Marie Smith | Dermatology | 21097 Ne 27th Ct Ste 500, Miami, FL 33180-1235 | 2019-11-15 |
| 1376188383 | Enchantress Dermatology, Inc. | Dermatology | 241 Nw 119 Ave, Miami, FL 33182-1329 | 2019-11-13 |
| 1699319988 | Revivify Dermatology, LLC | Dermatology | 21301 Powerline Rd # 108, Boca Raton, FL 33433-2388 | 2019-10-30 |
| 1841833928 | Carly Marie Maher | Dermatology | 90 Cypress Way E Ste 50, Naples, FL 34110-9275 | 2019-10-22 |
| Find all providers with the same taxonomy | ||||
| City | PANAMA CITY |
| Zip Code | 32405 |
Please comment or provide details below to improve the information on SOUTHEASTERN DERMATOLOGY GROUP PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.