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JACKSONVILLE SKIN CANCER CENTER P.A. NPI 1780861781


NPI Information

NPI: 1780861781
Provider Name: JACKSONVILLE SKIN CANCER CENTER, P.A.
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 10D1007515

Address:
4465 BAYMEADOWS RD STE 5
JACKSONVILLE, FL
ZIP 32217
Phone: (904) 737-0111
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JACKSONVILLE SKIN CANCER CENTER, P.A. is a mohs-micrographic surgery dermatology in Jacksonville, FL. The provider is 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. JACKSONVILLE SKIN CANCER CENTER, P.A. NPI is 1780861781. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

4465 BAYMEADOWS RD STE 5
JACKSONVILLE, FL
ZIP 32217-727
Phone: (904) 737-0111
Fax: (904) 737-4422

The provider's authorized official is Michael Edward Lutz .
The authorized official title is President and has the following contact phone number (904) 737-0111.

The CLIA number assigned to this NPI record is 10D1007515 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 1/22/2008 and was last updated on 12/21/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatologyNo
2207ND0900XDermatologyDermatopathologyNo
3207NS0135XDermatologyProcedural DermatologyNo
4207ND0101XDermatologyMOHS-Micrographic SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1DB9233MEDICARE PINFLORIDA
242484OTHERFLORIDABLUE CROSS BLUE SHIELD
3K5737MEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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