Organization
GENESIS DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYCE A EARLE (CHIEF OPERATIONS MANAGER)
(541) 663-0007
Entity
Organization
Contact information
Practice address
1902 4TH ST STE 3, LA GRANDE, OR 97850-2558
(541) 663-0007
(541) 663-0010
Mailing address
1902 4TH ST STE 3, LA GRANDE, OR 97850-2558
(541) 663-0007
(541) 663-0010
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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