Organization
ADVANCED DERMATOLOGY OF WYOMING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA CRANDALL (CREDENTIALING COORDINATOR)
(970) 484-3050
Entity
Organization
Contact information
Practice address
62 SOUTH REDMOND STREET, JACKSON, WY 83001-8664
(307) 734-5864
Mailing address
PO BOX 7406, JACKSON, WY 83002-7406
(307) 734-5864
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
06/21/2016
Last updated
10/06/2016
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