SOUTHEASTERN DERMATOLOGY GROUP PA
Dermatology at Harrison Ave, Panama City, FL

License number
Florida 95816
Category
Osteopathic Medicine
Type
Dermatology
Owner
Name: JON WARD MD
Title: PRESIDENT
Phone: (850) 233-3376
Address
Address
2505 Harrison Ave, Panama City, FL 32405
National Provider ID: 1518972231
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SOUTHEASTERN DERMATOLOGY GROUP, PA

Panama City, FL

Status:
Inactive
Inactive reason:
AMENDED AND RESTATEDARTICLES/NAME CHANGE
Registration:
May 8, 2006
Inactive since:
Jul 11, 2014
Addresses:
2505 Harrison Ave, Panama City, FL 32405 (Physical)
2420 Jenks Ave, Panama City, FL 32405
PO Box 18977, Panama City, FL 32417
State ID:
P06000064859
Business type:
Florida Profit Corporation
Managers:
Jon R Ward (President, Treasurer, Secretary), 2505 Harrison Ave, Panama City, FL 32405 (Physical),Michael A Stickler (Vice President), 2505 Harrison Ave, Panama City, FL 32405 (Physical),Hannah S. Ross Manager, inactive,...
Agent:
Jon Ward,2505 Harrison Ave, Panama City, FL 32405 (Physical)
EIN:
20-4857035

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