Organization
SILVER FALLS DERMATOLOGY, LLC
Active
Other names
Silver Falls Dermatology, PC, FRONTIER DERMATOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
MALISSA KOBBEVIK (CREDENTIALING MANAGER)
(360) 375-2038
Entity
Organization
Contact information
Practice address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Mailing address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MD26178
OR
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2034282
—
WA
05
—
247588
—
OR
Enumeration date
08/18/2008
Last updated
10/17/2024
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