Provider Demographics
NPI:1548271794
Name:DERMPATH PLUS INC
Entity type:Organization
Organization Name:DERMPATH PLUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-760-5104
Mailing Address - Street 1:829 GOLF ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2781
Mailing Address - Country:US
Mailing Address - Phone:813-641-0130
Mailing Address - Fax:
Practice Address - Street 1:5946 FROND WAY
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2647
Practice Address - Country:US
Practice Address - Phone:813-641-0466
Practice Address - Fax:813-641-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD022804207ZD0900X
IDM8087207ZD0900X
FLME86922207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16802OtherBSBC
H31466Medicare UPIN
FLE9168Medicare ID - Type Unspecified