| Entity Name: | MID-FLORIDA DERMATOLOGY ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Aug 1995 (29 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 08 Jun 2023 (2 years ago) |
| Document Number: | P95000060797 |
| FEI/EIN Number | 593330433 |
| Address: | 7652 Ashley Park Court, Orlando, FL, 32806, US |
| Mail Address: | 7652 ASHLEY PARK COURT, SUITE 305, ORLANDO, FL, 32806, US |
| ZIP code: | 32806 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | MID-FLORIDA DERMATOLOGY ASSOCIATES, P.A., MISSISSIPPI | 1040339 | MISSISSIPPI |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619018561 | 2007-02-12 | 2023-03-08 | 7652 ASHLEY PARK CT, SUITE 305, ORLANDO, FL, 328356199, US | 7652 ASHLEY PARK CT, SUITE 305, ORLANDO, FL, 328356199, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 407-299-7333 |
| Fax | 4072932049 |
Authorized person
| Name | RITA K DOBSON |
| Role | CREDENTIALING DIR. |
| Phone | 4072997333 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | No |
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ MICHAEL M | Agent | 7652 ASHLEY PARK COURT, ORLANDO, FL, 32835 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ MICHAEL M | President | 7652 Ashley Park Court, Orlando, FL, 32826 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ MICHAEL M | Secretary | 7652 Ashley Park Court, Orlando, FL, 32826 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ MICHAEL M | Treasurer | 7652 Ashley Park Court, Orlando, FL, 32826 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ MICHAEL M | Director | 7652 Ashley Park Court, Orlando, FL, 32826 |
| GUTIERREZ LINDSEY M | Director | 7652 Ashley Park Court, Orlando, FL, 32826 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000127804 | NORTHSHORE DERMATOLOGY | ACTIVE | 2023-10-16 | 2028-12-31 | No data | 7652 ASHLEY PARK CT, STE 306, ORLANDO, FL, 32835 |
| G23000060803 | VOLUSIA PLASTIC SURGERY | ACTIVE | 2023-05-15 | 2028-12-31 | No data | 7652 ASHLEY PARK CT, STE 305, ORLANDO, FL, 32835 |
| G23000058800 | VOLUSIA PLASTIC SURGERY CENTER | ACTIVE | 2023-05-09 | 2028-12-31 | No data | 7652 ASHLEY PARK CT, STE 306, ORLANDO, FL, 32835 |
| G21000118549 | MID FLORIDA INSTITUTE OF PLASTIC SURGERY | ACTIVE | 2021-09-15 | 2026-12-31 | No data | 7652 ASHLEY PARK CT., STE 30, ORLANDO, FL, 32835 |
| G21000074819 | MID FLORIDA ALLERGY | ACTIVE | 2021-06-03 | 2026-12-31 | No data | 7652 ASHLEY PARK CT., STE 305, ORLANDO, FL, 32835 |
| G21000074821 | MID FLORIDA ALLERGY & ATOPIC ECZEMA | ACTIVE | 2021-06-03 | 2026-12-31 | No data | 7652 ASHLEY PARK CT., STE 305, ORLANDO, FL, 32835 |
| G21000074824 | MID FLORIDA ALLERGY & ASTHMA | ACTIVE | 2021-06-03 | 2026-12-31 | No data | 7652 ASHLEY PARK CT., STE 305, ORLANDO, FL, 32835 |
| G21000068687 | CLEAR CHOICE DERMATOLOGY OF FL | ACTIVE | 2021-05-20 | 2026-12-31 | No data | 7652 ASHLEY PARK CT., STE 305, ORLANDO, FL, 32835 |
| G17000048540 | MID-FLORIDA DERMATOLOGY | ACTIVE | 2017-05-03 | 2027-12-31 | No data | 7652 ASHLEY PARK CT, STE 306, ORLANDO, FL, 32835 |
| G17000001601 | MID FLORIDA MEDICAL CORPORATION | ACTIVE | 2017-01-05 | 2027-12-31 | No data | 7652 ASHLEY PARK CT, STE 306, ORLANDO, FL, 32835 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-08-12 | GUTIERREZ, MICHAEL M | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-08-12 | 7652 ASHLEY PARK COURT, SUITE 305, ORLANDO, FL 32835 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-17 | 7652 Ashley Park Court, Suite 305, Orlando, FL 32806 | No data |
| AMENDMENT | 2023-06-08 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2009-01-27 | 7652 Ashley Park Court, Suite 305, Orlando, FL 32806 | No data |
| NAME CHANGE AMENDMENT | 2006-06-30 | MID-FLORIDA DERMATOLOGY ASSOCIATES, P.A. | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-08-12 |
| Reg. Agent Resignation | 2024-08-12 |
| ANNUAL REPORT | 2024-04-17 |
| Amendment | 2023-06-08 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-03-15 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-04-15 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-03-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
