Organization
JORDAN VALLEY DERMATOLOGY
Active
Other names
Jordan Valley Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGINIA LOUISE TUBBS NP (OWNER)
(307) 265-2936
Entity
Organization
Contact information
Practice address
428 S DURBIN ST STE 103, CASPER, WY 82601-2829
(307) 234-0003
(307) 265-6575
Mailing address
428 S DURBIN ST STE 103, CASPER, WY 82601-2829
(307) 234-0003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8624096-4405
UT
Other
Enumeration date
07/08/2013
Last updated
06/21/2019
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