Organization
GRAND ISLAND DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK L SHERIDAN (ADMINISTRATOR)
(308) 384-9300
Entity
Organization
Contact information
Practice address
418 N WEBB RD, GRAND ISLAND, NE 68803-4045
(308) 384-9300
(308) 384-4542
Mailing address
PO BOX 5436, GRAND ISLAND, NE 68802-5436
(308) 384-9300
(308) 384-4542
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
22426
NE
207N00000X
Dermatology Physician
Primary
22426
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01726
BCBS OF NE
NE
05
—
10025016800
—
NE
Enumeration date
03/24/2006
Last updated
07/21/2022
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