Organization
AZEAL DERMATOLOGY INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY PILKINGTON D.O. (OWNER)
(303) 530-9325
Entity
Organization
Contact information
Practice address
5365 SPINE RD, SUITE C, BOULDER, CO 80301-3324
(303) 530-9325
Mailing address
PO BOX 7446, LOVELAND, CO 80537-0446
(970) 663-2742
(970) 667-0847
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77885376
—
CO
Enumeration date
03/12/2015
Last updated
09/15/2015
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