Organization
BLACK HILLS DERMATOLOGY PC
Active
Other names
Spearfish Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON W GORMAN (ADMINISTRATOR)
(605) 341-5565
Entity
Organization
Contact information
Practice address
132 E GRANT ST, SPEARFISH, SD 57783-2424
(605) 722-9090
(605) 722-9909
Mailing address
PO BOX 6540, 7236 JORDAN DRIVE STE 101, RAPID CITY, SD 57709-6540
(605) 341-5565
(605) 341-5595
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0370
SD
207ND0101X
MOHS-Micrographic Surgery Physician
0370
SD
207ND0900X
Dermatopathology Physician
0370
SD
207NP0225X
Pediatric Dermatology Physician
0370
SD
Other
Enumeration date
05/22/2008
Last updated
01/30/2015
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