Organization
SKIN PC
Active
Other names
Ideal Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHN MOTT MD (AUTHORIZED REP)
(303) 569-7700
Entity
Organization
Contact information
Practice address
335 W SOUTH BOULDER RD STE 3, LOUISVILLE, CO 80027-1192
(970) 667-3116
(970) 669-0159
Mailing address
PO BOX 7065, LOVELAND, CO 80537-0065
(970) 667-3116
(970) 669-0159
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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