NPI 1023276607

Southside Dermatology, P.A.

Organisation Specialist Jacksonville, FL

Practice location

Address: 4727 Sunbeam Rd Suite 101, Jacksonville, FL 32257-6107
Phone: (904) 880-0622
Fax: (904) 880-0623

Authorised official

Name: Mary Trinh Pentel
Title: President
Phone: (904) 880-0622

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence ME16473 (FL)

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Registry record

NPI: 1023276607
Entity type: Organization
NPI issued: 29 May 2008
Record last updated: 2 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.