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  5. MOUM DERMATOLOGY, LLC

MOUM DERMATOLOGY, LLC

Company Details

Entity Name: MOUM DERMATOLOGY, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 07 Mar 2013 (12 years ago)
Date of dissolution: 28 Dec 2020 (4 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 28 Dec 2020 (4 years ago)
Document Number: L13000034873
FEI/EIN Number 46-2246996
Address: 2800 S Seacrest Blvd, Suite 280, Boynton Beach, FL, 33435, US
Mail Address: 2800 S Seacrest Blvd, Suite 280, Boynton Beach, FL, 33435, US
ZIP code: 33435
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1649616970 2013-05-14 2013-05-14 445 S FEDERAL HWY, BOCA RATON, FL, 334326027, US 445 S FEDERAL HWY, BOCA RATON, FL, 334326027, US

Contacts
Phone +1 561-395-8701
Fax 5613679338

Authorized person
Name DR. ERIC EE MOUM
Role PRESIDENT
Phone 5613958701

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number ME0058720
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MOUM DERMATOLOGY, LLC 401(K) PROFIT SHARING PLAN 2017 462246996 2018-12-04 MOUM DERMATOLOGY, LLC 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 5613958701
Plan sponsor’s address 2800 S. SEACREST BOULEVARD, SUITE 280, BOYNTON BEACH, FL, 33435

Signature of
Role Plan administrator
Date 2018-12-04
Name of individual signing ERIC MOUM
Valid signature Filed with authorized/valid electronic signature
MOUM DERMATOLOGY, LLC 401(K) PROFIT SHARING PLAN 2017 462246996 2018-05-14 MOUM DERMATOLOGY, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 5613958701
Plan sponsor’s address 2800 S. SEACREST BOULEVARD, SUITE 280, BOYNTON BEACH, FL, 33435

Signature of
Role Plan administrator
Date 2018-05-14
Name of individual signing ERIC MOUM
Valid signature Filed with authorized/valid electronic signature
MOUM DERMATOLOGY, LLC 401(K) PROFIT SHARING PLAN 2016 462246996 2017-06-26 MOUM DERMATOLOGY, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 5613958701
Plan sponsor’s address 2800 S. SEACREST BOULEVARD, SUITE 280, BOYNTON BEACH, FL, 33435

Signature of
Role Plan administrator
Date 2017-06-26
Name of individual signing ERIC MOUM
Valid signature Filed with authorized/valid electronic signature
MOUM DERMATOLOGY, LLC 401(K) PROFIT SHARING PLAN 2015 462246996 2016-10-04 MOUM DERMATOLOGY, LLC 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 5613958701
Plan sponsor’s address 2800 S. SEACREST BOULEVARD, SUITE 280, BOYNTON BEACH, FL, 33435

Signature of
Role Plan administrator
Date 2016-10-04
Name of individual signing ERIC MOUM
Valid signature Filed with authorized/valid electronic signature
MOUM DERMATOLOGY, LLC 401(K) PROFIT SHARING PLAN 2014 462246996 2015-07-16 MOUM DERMATOLOGY, LLC 0
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 5613958701
Plan sponsor’s address 2800 S. SEACREST BOULEVARD, SUITE 280, BOYNTON BEACH, FL, 33435

Signature of
Role Plan administrator
Date 2015-07-16
Name of individual signing DR. ERIC E. MOUM
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MOUM ERIC E Agent 1032 VISTA DEL MAR DRIVE N, DELRAY BEACH, FL, 33483

Managing Member

Name Role Address
MOUM ERIC E Managing Member 1032 VISTA DEL MAR DRIVE N, DELRAY BEACH, FL, 33483

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2020-12-28 No data No data
CHANGE OF PRINCIPAL ADDRESS 2015-04-13 2800 S Seacrest Blvd, Suite 280, Boynton Beach, FL 33435 No data
CHANGE OF MAILING ADDRESS 2015-04-13 2800 S Seacrest Blvd, Suite 280, Boynton Beach, FL 33435 No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2020-12-28
ANNUAL REPORT 2020-03-12
ANNUAL REPORT 2019-04-23
ANNUAL REPORT 2018-03-14
ANNUAL REPORT 2017-04-03
ANNUAL REPORT 2016-01-25
ANNUAL REPORT 2015-04-13
ANNUAL REPORT 2014-03-27
Florida Limited Liability 2013-03-07

Related by officers

MOUM ERIC E

ATLANTIC SKY PROPERTIES LLC SEACREST ENTERPRISES REALTY AND LEASING, LLC FOUR HUNDRED ENTERPRISES, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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