GULF COAST DERMATOLOGY & SKIN CARE CENTRE PLLC (NPI# 1750629788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750629788 |
| Entity Type | Organization |
| Organization Name | GULF COAST DERMATOLOGY & SKIN CARE CENTRE PLLC |
| Other Organization Name | ADVANCED DERMATOLOGY & SKIN CARE CENTRE PLLC |
| Practice Address |
4554 E Highway 20 Niceville FL 32578-9755 |
| Mailing Address |
6701 Airport Blvd Suite D232 Mobile AL 36608-6705 |
| Practice Telephone | 2516313570 |
| Practice Fax Number | 2516313572 |
| Mailing Telephone | 2516313570 |
| Mailing Fax Number | 2516313572 |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2013-01-25 |
| Authorized Official Name | DR. THOMAS W. BENDER III (OWNER) |
| Authorized Official Telephone | 2516313570 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Advanced Dermatology & Skin Care Centre PLLC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184078024 | Gulf Coast Dermatology & Skin Care Centre Pllc | Pharmacy | 580 Providence Park Dr E Ste 202, Suite 202, Mobile, AL 36695-4614 | 2016-04-18 |
| 1891179727 | Gulf Coast Dermatology & Skin Care Centre Pllc | Dermatology | 6701 Airport Blvd Ste D232, Mobile, AL 36608-6757 | 2015-07-09 |
| 1336523265 | Gulf Coast Dermatology & Skin Care Centre Pllc | Dermatology | 580 Providence Park Dr E, Mobile, AL 36695-4614 | 2015-07-09 |
| 1922346956 | Gulf Coast Dermatology & Skin Care Centre Pllc | Dermatology | 10800 Panama City Beach Pkwy, Suite 200, Panama City Beach, FL 32407-2533 | 2013-01-25 |
| 1205174232 | Gulf Coast Dermatology & Skin Care Centre Pllc | Dermatology | 7720 Us Highway 98 W, Suite 340, Miramar Beach, FL 32550-7230 | 2013-01-25 |
| 1750614301 | Gulf Coast Dermatology & Skin Care Centre Pllc | Dermatology | 580 Providence Park Dr E, Second Floor, Mobile, AL 36695-4614 | 2009-09-15 |
| Street Address |
4554 E HIGHWAY 20 |
| City | NICEVILLE |
| State | FL |
| Zip Code | 32578-9755 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962494211 | Kapil Puri | Urology | 4554 E Highway 20, Niceville, FL 32578-9755 | 2005-08-22 |
| 1043821366 | Tyler Belser Goodman | Physical Therapist | 4554 E Highway 20, Niceville, FL 32578-9755 | 2020-08-11 |
| 1154971893 | Pamela Kay Steele | Physical Therapist | 4554 E Highway 20, Niceville, FL 32578-9755 | 2019-09-15 |
| 1578055976 | Sydney Morgan Howk | Nurse Practitioner | 4554 E Highway 20, Niceville, FL 32578-9755 | 2018-05-31 |
| 1831586312 | Leeward Medical LLC | Internal Medicine | 4554 E Highway 20, Niceville, FL 32578-9755 | 2015-04-22 |
| 1760783294 | Jessica Brooke Rapa | Physician Assistant | 4554 E Highway 20, Niceville, FL 32578-9755 | 2010-11-15 |
| 1508054594 | Access Medical Group, Inc. | Family Medicine | 4554 E Highway 20, Niceville, FL 32578-9755 | 2007-10-04 |
| 1154537330 | Alice Ruth Mcconnell | Massage Therapist | 4554 E Highway 20, Niceville, FL 32578-9755 | 2007-05-15 |
| 1366458408 | Allan L. Fedosky | Family Medicine | 4554 E Highway 20, Niceville, FL 32578-9755 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376028563 | Southern Breeze Healthcare | Family Medicine | 4556 E Hwy 20, Suite 105, Niceville, FL 32578 | 2018-10-03 |
| 1497252860 | Molly Marie Everitt | Physician Assistant | 2190 Fl-85 N, Niceville, FL 32578 | 2018-04-11 |
| 1972009314 | Alexis Aust | Student in an Organized Health Care Education/Training Program | 104 Arrowhead Way, Niceville, FL 32578 | 2018-04-04 |
| 1518488949 | Michelle Sasala | Nurse Practitioner | 4550 E Highway 20, Niceville, FL 32578 | 2017-07-06 |
| 1003336199 | Comfortable Care Denta Health Professionals, Pa | Dentist | 1386 E John Sims Parkway, Niceville, FL 32578 | 2017-06-21 |
| 1306223888 | Emerald Coast Periodontics | Dentist | 719 Bayshore Drive, Niceville, FL 32578 | 2015-05-04 |
| 1538586136 | Pamela Ottesen Dmd LLC | Dentist | 1536 John Sims Pkwy, Niceville, FL 32578 | 2014-03-21 |
| 1417204066 | Mary Jo Stiles | Hearing Instrument Specialist | 4400 Hwy, 20 East, Suite # 211, Niceville, FL 32578 | 2012-08-13 |
| 1093086563 | Pat T. Tidwell Md Pa | Clinic/Center | 4554 Highway 20 East, Niceville, FL 32578 | 2012-01-16 |
| 1952683260 | Gentle Birth Options, LLC | Nurse Practitioner | 296 Bayshore Drive, Niceville, FL 32578 | 2011-09-13 |
| Find all providers in zip 32578 | ||||
| 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 |
|---|---|---|---|---|
| 1740472380 | Layne Marc Fielder | Dermatology | 4400 Highway 20 E, Suite 410, Niceville, FL 32578 | 2007-08-17 |
| 1346222957 | Peter Viksnins | Dermatology | 554 Highway 85 N, Medical Center Dermatology and Skin Surgery Center #e, Niceville, FL 32578-1045 | 2005-11-18 |
| 1427033463 | Elizabeth A Clark | Dermatology | 4400 E Highway 20, Ste 410, Niceville, FL 32578-8779 | 2005-12-13 |
| 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 | ||||
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| 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.