| Entity Name: | ASSOCIATES IN MEDICAL AND SURGICAL DERMATOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Nov 1999 (25 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: | P99000098565 |
| FEI/EIN Number | 593614002 |
| Address: | 9125 CORSEA DEL FONTANA WAY SUITE 100, NAPLES, FL, 34109 |
| Mail Address: | 9125 CORSEA DEL FONTANA WAY SUITE 100, NAPLES, FL, 34109 |
| ZIP code: | 34109 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275538274 | 2005-06-16 | 2020-08-22 | 9125 CORSEA DEL FONTANA WAY, # 100, NAPLES, FL, 341094396, US | 9125 CORSEA DEL FONTANA WAY, # 100, NAPLES, FL, 341094396, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 239-598-4004 |
| Fax | 2395984713 |
Authorized person
| Name | DR. DAVID SETH GOODMAN |
| Role | PRESIDENT |
| Phone | 2395984004 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | TUCKER BLUE CROSS # |
| Number | 42568 |
| State | FL |
| Issuer | GOODMAN BLUE CROSS # |
| Number | 04756 |
| State | FL |
| Issuer | GROUP BLUE CROSS # |
| Number | 45192 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOODMAN DAVID S | Agent | 9125 CORSEA DEL FONTANA WAY, NAPLES, FL, 34109 |
| Name | Role | Address |
|---|---|---|
| GOODMAN DAVID S | Director | 9125 CORSEA DEL FONTANA WAY SUITE 100, NAPLES, FL, 34109 |
| Name | Role | Address |
|---|---|---|
| GOODMAN DAVID S | President | 9125 CORSEA DEL FONTANA WAY SUITE 100, NAPLES, FL, 34109 |
| Name | Role | Address |
|---|---|---|
| TUCKER MICHAEL S | Vice President | 9125 CORSEA DEL FONTANA WAY SUITE 100, NAPLES, FL, 34109 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-14 | 9125 CORSEA DEL FONTANA WAY, STE 100, NAPLES, FL 34109 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-03-02 | 9125 CORSEA DEL FONTANA WAY SUITE 100, NAPLES, FL 34109 | No data |
| CHANGE OF MAILING ADDRESS | 2005-03-02 | 9125 CORSEA DEL FONTANA WAY SUITE 100, NAPLES, FL 34109 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-14 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-04-10 |
| ANNUAL REPORT | 2013-03-25 |
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-01-07 |
| ANNUAL REPORT | 2010-02-23 |
| ANNUAL REPORT | 2009-02-25 |
| ANNUAL REPORT | 2008-01-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
