Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bold City Dermatology LLC

Organization Dermatology Physician · NPI 1538761655

Bold City Dermatology LLC is a Dermatology Physician in St Augustine, Florida. Registered with an NPI since 2020.

In the registry since
2020
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

316 Paseo Reyes Dr
St Augustine, FL 32095-8464
Phone: (904) 544-5800
Fax: (904) 544-5800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

MOHS-Micrographic Surgery Physician (primary) Taxonomy 207ND0101X
Dermatology Physician Taxonomy 207N00000X
Pediatric Dermatology Physician Taxonomy 207NP0225X
Procedural Dermatology Physician Taxonomy 207NS0135X

Record details

NPI number1538761655
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Bishr Al Dabagh — Owner · (704) 230-1302
NPI enumeratedNovember 13, 2020
Last updated in NPPESJanuary 26, 2021
Certification dateJanuary 26, 2021
Mailing address316 Paseo Reyes Dr, St Augustine, FL 32095-8464

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