10D2059743 CLIA NUMBER - SOUTHEASTERN DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 10D2059743
  • Facility Name: SOUTHEASTERN DERMATOLOGY
  • Facility Address: 555 N BYRON BUTLER PKWY
    PERRY, FL
    ZIP 32347
  • Facility Phone: 850 422-3376
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MICHAEL J. FORD
  • NPI Number: 1841229036
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 10D2059743
LAB Type Physician Office
Facility Name SOUTHEASTERN DERMATOLOGY
Street 555 N BYRON BUTLER PKWY
City PERRY
State FL
ZIP 32347
Phone 850 422-3376
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Physician Office
Lab Director MICHAEL J. FORD

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This page was last updated on: 9/29/2025