Organization
PROVIDENCE DERMATOLOGY LLC
Active
Other names
Providence Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS S JAMES DO (OWNER/PHYSICIAN)
(435) 554-1182
Entity
Organization
Contact information
Practice address
169 N GATEWAY DR STE 100, PROVIDENCE, UT 84332-9860
(541) 999-4475
Mailing address
169 N GATEWAY DR STE 100, PROVIDENCE, UT 84332-9860
(435) 554-1182
(435) 554-1950
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Enumeration date
05/22/2019
Last updated
06/16/2025
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