| Entity Name: | INTEGRATED DERMATOLOGY OF GAINESVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 25 Sep 2017 (7 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L17000198006 |
| FEI/EIN Number | 36-4883561 |
| Address: | 4700 EXCHANGE COURT, SUITE 110, BOCA RATON, FL 33431 |
| Mail Address: | 4700 EXCHANGE COURT, SUITE 110, BOCA RATON, FL 33431 |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588170591 | 2017-12-28 | 2018-02-02 | 4700 EXCHANGE CT STE 110, BOCA RATON, FL, 334314450, US | 3700 NW 83RD ST, GAINESVILLE, FL, 326065603, US | |||||||||||||||||||
|
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| Phone | +1 561-314-2000 |
| Fax | 5614312821 |
| Phone | +1 352-371-7546 |
| Fax | 3523357546 |
Authorized person
| Name | JEFFREY D. QUEEN |
| Role | AUTHORIZED GROUP OFFICIAL |
| Phone | 5613142000 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| DERM HOLDINGS LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PLOTKIN, ADAM S | Managing Member | 4700 EXCHANGE COURT, SUITE 110 BOCA RATON, FL 33431 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000137450 | FLORIDA SKIN CANCER AND DERMATOLOGY SPECIALIST | EXPIRED | 2017-12-15 | 2022-12-31 | No data | 4700 EXCHANGE COURT, SUITE 110, BOCA RATON, FL, 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| LC AMENDMENT | 2018-01-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-03-28 |
| ANNUAL REPORT | 2018-06-27 |
| LC Amendment | 2018-01-16 |
| Florida Limited Liability | 2017-09-25 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
