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Organization
DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
Active
Organization
DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER DIVINE M.D. (OWNER)
(970) 388-2850
Entity
Organization
Contact information
Practice address
1260 DOCTORS LN, FORT COLLINS, CO 80524-4038
(813) 765-8453
Mailing address
1260 DOCTORS LN STE A, FORT COLLINS, CO 80524-4072
(970) 286-2668
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
DR.0058205
CO
Other
Enumeration date
04/06/2017
Last updated
09/10/2024
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