Provider Demographics
NPI:1730173709
Name:FLORIDA SKIN CENTER INC
Entity type:Organization
Organization Name:FLORIDA SKIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAIS
Authorized Official - Middle Name:AURORA
Authorized Official - Last Name:BADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO MD
Authorized Official - Phone:239-561-3376
Mailing Address - Street 1:13691 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4318
Mailing Address - Country:US
Mailing Address - Phone:239-561-3376
Mailing Address - Fax:239-561-3020
Practice Address - Street 1:13691 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4318
Practice Address - Country:US
Practice Address - Phone:239-561-3376
Practice Address - Fax:239-561-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL05007304207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58688OtherBCBS
FLH38305Medicare UPIN