JACKSONVILLE SKIN CANCER CENTER, P.A. (NPI# 1780861781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780861781 |
| Entity Type | Organization |
| Organization Name | JACKSONVILLE SKIN CANCER CENTER, P.A. |
| Practice Address |
4465 Baymeadows Rd Ste 5 Jacksonville FL 32217-4727 |
| Practice Telephone | 9047370111 |
| Practice Fax Number | 9047374422 |
| Mailing Telephone | 9047370111 |
| Mailing Fax Number | 9047374422 |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2012-12-21 |
| Authorized Official Name | MICHAEL EDWARD LUTZ (PRESIDENT) |
| Authorized Official Telephone | 9047370111 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS BLUE SHIELD | 42484 | 01 |
| Street Address |
4465 BAYMEADOWS RD STE 5 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32217-4727 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336605005 | Mary Ellen Mccullough-list | Behavior Technician | 3437 Miruelo Circle North, Jacksonville, FL 32217 | 2019-02-18 |
| 1285131656 | Priority One Home Care LLC | In Home Supportive Care | 7500 Powers Ave Apt 198, Jacksonville, FL 32217 | 2018-04-11 |
| 1407361272 | Sharon Williams | Home Health | 8300 Plaza Gate Lane #1152, Jacksonville, FL 32217 | 2017-12-02 |
| 1548779929 | Acumed Medical Ltd. | Durable Medical Equipment & Medical Supplies | 6653 Powers Avenue, Suite 134, Jacksonville, FL 32217 | 2017-09-28 |
| 1437685526 | Ward Zeigler | Behavior Technician | 3437 Miruelo Cr. N., Jacksonville, FL 32217 | 2017-05-10 |
| 1538695754 | Shilonda Peterson-jackson | Technician, Other | 3437 Miruelo Cr N, Jacksonville, FL 32217 | 2017-05-08 |
| 1114467834 | Louis R. Lothman | Counselor | 3734 San Viscaya Dr., Jacksonville, FL 32217 | 2017-02-28 |
| 1023490141 | A Gentle Touch Home Health Care LLC. | Home Health | 5991 Chester Avenue, Jacksonville, FL 32217 | 2015-06-25 |
| 1912320334 | Christopher Marshall Fuller | Developmental Therapist | 5132 Edgeware Ct., Jacksonville, FL 32217 | 2014-01-22 |
| 1790040020 | Maria R. Tapia | Psychologist | 7680 Smullian Trail West, Jacksonville, FL 32217 | 2012-07-12 |
| Find all providers in zip 32217 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457321028 | Juan A Rosario-collazo | Dermatology | 4479 Baymeadows Rd, Jacksonville, FL 32217-4716 | 2006-01-25 |
| 1841825791 | Beal Dermatology, Pllc | Dermatology | 6817 Southpoint Pkwy Ste 101, Jacksonville, FL 32216-6285 | 2020-03-10 |
| 1801379409 | Bellavista Dermatology Group LLC | Dermatology | 3636 University Blvd S, Unit B2, Jacksonville, FL 32216 | 2018-09-10 |
| 1336553619 | Precision Dermatology and Skin Surgery Pa | Dermatology | 1550 Riverside Ave, Jacksonville, FL 32204-4161 | 2014-06-16 |
| 1518232065 | Sca Dermatology, LLC | Dermatology | 915 W Monroe St, S. 101, Jacksonville, FL 32204-1177 | 2012-03-16 |
| 1437389772 | Leavitt Medical Associates of Florida Inc | Dermatology | 4100 Southpoint Dr E, Suite 1, Jacksonville, FL 32216-8017 | 2009-07-21 |
| 1942430285 | Leavitt Medical Associates of Florida Inc | Dermatology | 14810 Old Saint Augustine Rd, Suite 100, Jacksonville, FL 32258-2466 | 2009-07-21 |
| 1366672610 | Leavitt Medical Associates of Florida Inc | Dermatology | 14546 Old Saint Augustine Rd, Suite 407, Jacksonville, FL 32258-5468 | 2009-07-21 |
| 1508092347 | James Scott Trimble | Dermatology | 6890 Belfort Oaks Pl, Jacksonville, FL 32216-6241 | 2009-06-08 |
| 1598753717 | Henry Walter Randle | Dermatology | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-10-11 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32217 |
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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.