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THE DERMATOLOGY CENTER, LLC 1500 Dodson Avenue, Suite 270 P.O.BOX 1644 Fort Smith, AR 72902 Phone: (479)7097340 Fax: (479) 7097484Authorization to Use and Disclose Protected Health Information PLEASE

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What is form dermatology center pllc?

Form Dermatology Center PLLC is a legal document required for the establishment and operation of a dermatology practice structured as a Professional Limited Liability Company (PLLC).

Who is required to file form dermatology center pllc?

Individuals or groups who want to operate a dermatology practice as a PLLC must file this form, including licensed dermatologists.

How to fill out form dermatology center pllc?

To fill out Form Dermatology Center PLLC, provide the required information such as the name of the PLLC, its purpose, details of the members, and other relevant business information as specified in the form instructions.

What is the purpose of form dermatology center pllc?

The purpose of Form Dermatology Center PLLC is to legally establish a dermatology practice as a professional limited liability company, ensuring compliance with state laws and regulations.

What information must be reported on form dermatology center pllc?

The form typically requires the PLLC name, the names and qualifications of the members, the principal office address, and any other information as mandated by state regulations.

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