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Organization

LP DERM LLC

Active
Parent organization
LP DERM LLC
Other names
Lone Pine Dermatology
Organization subpart
Yes

Provider details

NPI number
Legal business name
LP DERM LLC
Authorized official
CORY B MAUGHAN DO (OWNER)
(435) 554-8442
Entity
Organization

Contact information

Practice address
517 W 100 N STE 103, PROVIDENCE, UT 84332-9824
(435) 554-8442
Mailing address
517 W 100 N STE 103, PROVIDENCE, UT 84332-9824
(435) 554-8442

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
207ND0101X
MOHS-Micrographic Surgery Physician

Other

Enumeration date
01/30/2023
Last updated
01/30/2023
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