Lake Wales Dermatology

LBN: Distinctive Dermatology Pllc
Lake Wales Dermatology is an health care organization with primary practice located at 134 E Tillman Ave , Lake Wales FL 33853-4130. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as the primary health care specialty. Distinctive Dermatology Pllc can be contacted via phone (863) 269-0790, or through Knisley, Raymond via phone (863) 269-0790.

Contact Information

Primary practice address
134 E Tillman Ave Lake Wales FL 33853-4130
Phone: (863) 269-0790
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Knisley, Raymond
Phone: (863) 269-0790

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X

Profile Details

NPI number 1962088138
LBN Legal business name Distinctive Dermatology Pllc
DBA Doing business as Lake Wales Dermatology
Authorized official Knisley, Raymond
Entity Organization
Organization subpart 1 No
Enumeration date Mar 19th, 2021
Last updated Apr 14th, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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