| Entity Name: | CLEARWATER DERMATOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
CLEARWATER DERMATOLOGY, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 01 Jul 1977 (48 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | 538243 |
| FEI/EIN Number |
591748009
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1122 DRUID ROAD, CLEARWATER, FL, 33756 |
| Mail Address: | 1122 DRUID ROAD, CLEARWATER, FL, 33756 |
| ZIP code: | 33756 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780659094 | 2006-02-21 | 2013-12-30 | 1122 DRUID RD E, CLEARWATER, FL, 337564100, US | 1122 DRUID RD E, CLEARWATER, FL, 337564100, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 727-461-2282 |
Authorized person
| Name | DR. ROGER STEVEN GOLOMB |
| Role | PRESIDENT |
| Phone | 7274612282 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME0021279 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA PROV CLWR DERM |
| Number | 0004563725 |
| State | FL |
| Issuer | UHC GROUP # CLWR DERM |
| Number | 0300627 |
| State | FL |
| Issuer | MEDICAID |
| Number | 250114700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOLOMB, ROGER S, M.D. | Director | 1122 DRUID ROAD, CLEARWATER, FL, 33756 |
| BURNS, GEORGE E, M.D. | President | 1122 DRUID ROAD., CLEARWATER, FL, 33756 |
| BURNS, GEORGE E, M.D. | Director | 1122 DRUID ROAD., CLEARWATER, FL, 33756 |
| GOLOMB, ROGER S., M.D. | TPD | 1122 DRUID ROAD, CLEARWATER, FL, 33756 |
| GOLOMB, ROGER S. | Agent | 1122 DRUID ROAD, CLEARWATER, FL, 33756 |
| GOLOMB, ROGER S, M.D. | Secretary | 1122 DRUID ROAD, CLEARWATER, FL, 33756 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 1999-02-22 | 1122 DRUID ROAD, CLEARWATER, FL 33756 | - |
| CHANGE OF MAILING ADDRESS | 1999-02-22 | 1122 DRUID ROAD, CLEARWATER, FL 33756 | - |
| REGISTERED AGENT ADDRESS CHANGED | 1999-02-22 | 1122 DRUID ROAD, CLEARWATER, FL 33756 | - |
| NAME CHANGE AMENDMENT | 1988-06-30 | CLEARWATER DERMATOLOGY, P.A. | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-03-07 |
| ANNUAL REPORT | 2016-03-17 |
| ANNUAL REPORT | 2015-02-24 |
| ANNUAL REPORT | 2014-01-07 |
| ANNUAL REPORT | 2013-04-02 |
| ANNUAL REPORT | 2012-01-26 |
| ANNUAL REPORT | 2011-02-22 |
| ANNUAL REPORT | 2010-02-23 |
| ANNUAL REPORT | 2009-01-29 |
| ANNUAL REPORT | 2008-01-10 |
Date of last update: 01 Mar 2025
Sources: Florida Department of State
