Organization
J SEMMES MICKELWAIT MD PS
Active
Other names
Advanced Dermatology and Skin Renewal Center
Organization subpart
No
Provider details
NPI number
Authorized official
J SEMMES MICKELWAIT MD (OWNER)
(360) 424-4186
Entity
Organization
Contact information
Practice address
1420 ROOSEVELT AVE, SUITE 7, MOUNT VERNON, WA 98273-2687
(360) 424-4186
(360) 428-0927
Mailing address
1420 ROOSEVELT AVE, SUITE 7, MOUNT VERNON, WA 98273-2687
(360) 424-4186
(360) 428-0927
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
07/09/2006
Last updated
08/22/2020
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