Provider Demographics
NPI:1487947008
Name:CLEARLY DERM, LLC
Entity type:Organization
Organization Name:CLEARLY DERM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-299-3907
Mailing Address - Street 1:7050 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3426
Mailing Address - Country:US
Mailing Address - Phone:561-353-3376
Mailing Address - Fax:561-404-1170
Practice Address - Street 1:1760 N CONGRESS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8214
Practice Address - Country:US
Practice Address - Phone:561-739-9595
Practice Address - Fax:561-739-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10453OtherHCC
FLHCC9614OtherSTAE LICENSE
FLHCC9613OtherSTATE LICENSE