Organization
WEST RIVER DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER S KNUTSEN M.D. (PRESIDENT)
(605) 341-5910
Entity
Organization
Contact information
Practice address
717 MEADE ST, SUITE 100, RAPID CITY, SD 57701-5100
(605) 341-5910
(605) 341-9052
Mailing address
717 MEADE ST, SUITE 100, RAPID CITY, SD 57701-5100
(605) 341-5910
(605) 341-9052
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
0266
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003099
BLUE CROSS BLUE SHIELD
SD
Enumeration date
09/06/2006
Last updated
03/11/2008
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