Organization
DERMATOLOGY CLINIC, P.C.
Active
Organization
DERMATOLOGY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN WATERHOUSE (THIRD PARTY ADMINISTRATOR)
(719) 484-8842
Entity
Organization
Contact information
Practice address
3245 INTERNATIONAL CIR, SUITE 200, COLORADO SPRINGS, CO 80910-3152
(719) 484-8840
(719) 484-8845
Mailing address
3245 INTERNATIONAL CIR, SUITE 200, COLORADO SPRINGS, CO 80910-3152
(719) 484-8840
(719) 484-8845
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
98058363
—
CO
Enumeration date
02/13/2009
Last updated
05/21/2009
Update your record
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