Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME065381 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | ME065381 | FL |
N | 207ND0900X | Dermatopathologist | ME065381 | FL |
Y | 207NS0135X | Procedural Dermatology | ME065381 | FL |
NPI | 1043276124 |
---|---|
Provider Name | Theodore Andrew Schiff |
First Address | Palm Beach Gardens, FL 33410-4542 |
Second Address | Palm Beach Gardens, FL 33410-4542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43350 | BCBC FL PROVIDER # (01) | FL |
F59991 | (02) | FL |