| Entity Name: | WALL DERMATOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 May 2023 (2 years ago) |
| Document Number: | L23000260611 |
| FEI/EIN Number | 99-2085178 |
| Address: | 1700 66th St N, Ste 300, St. Petersburg, FL, 33710, US |
| Mail Address: | 3000 Boca Ciega Dr N, Saint Petersburg, FL, 33710, US |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003668328 | 2024-04-02 | 2024-08-05 | 3000 BOCA CIEGA DR N, SAINT PETERSBURG, FL, 337102834, US | 1700 66TH ST N STE 300, ST PETERSBURG, FL, 337105500, US | |||||||||||||
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| Phone | +1 727-432-3225 |
Authorized person
| Name | DR. WESTON WALL |
| Role | PHYSICIAN OWNER |
| Phone | 7274323225 |
Taxonomy
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WALL WESTON B | Agent | 4798 S. FLORIDA AVE, LAKELAND, FL, 33813 |
| Name | Role | Address |
|---|---|---|
| WALL WESTON B | Director | 3000 BOCA CIEGA DR N, SAINT PETERSBURG, FL, 33710 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-08-26 | 1700 66th St N, Ste 300, St. Petersburg, FL 33710 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-05 | 1700 66th St N, Ste 300, St. Petersburg, FL 33710 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| Florida Limited Liability | 2023-05-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
