Organization
FIFE DERMATOLOGY UTAH
Active
Parent organization
FIFE DERMATOLOGY, P.C.
Other names
Vivida Dermatology
Organization subpart
Yes
Provider details
NPI number
Legal business name
FIFE DERMATOLOGY, P.C.
Authorized official
DOUGLAS F FIFE MD (PRESIDENT/CEO)
(702) 255-6647
Entity
Organization
Contact information
Practice address
1490 E FOREMASTER DRIVE, SUITE 260, ST.GEORGE, UT 84790-4488
(435) 673-5373
(702) 673-5041
Mailing address
6460 MEDICAL CENTER ST STE 350, LAS VEGAS, NV 89148-2423
(702) 255-6647
(702) 920-8444
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270773333
TAX-ID
NV
01
—
CM808
MEDICARE
NV
Enumeration date
10/30/2017
Last updated
05/09/2018
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