Organization
DERMATOLOGY AND ENDOCRINOLOGY LLC
Active
Organization
DERMATOLOGY AND ENDOCRINOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM K DERNOVSEK MD (OWNER)
(719) 564-4500
Entity
Organization
Contact information
Practice address
1925 E ORMAN AVE, STE 115, PUEBLO, CO 81004-3500
(719) 564-4500
(719) 564-0304
Mailing address
1925 E ORMAN AVE, STE 115, PUEBLO, CO 81004-3537
(719) 564-4500
(719) 564-0304
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
26083
CO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
26084
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114999018
RAILROAD MEDICARE
CO
05
—
96378352
—
CO
Enumeration date
02/03/2006
Last updated
01/11/2016
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