Organization
SILVER FALLS DERMATOLOGY, LLC
Active
Organization
SILVER FALLS DERMATOLOGY, LLC
Active
Other names
FRONTIER DERMATOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
MALISSA KOBBEVIK (CREDENTIALING MANAGER)
(360) 375-2038
Entity
Organization
Contact information
Practice address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Mailing address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Taxonomy
Speciality
Code
Description
License number
State
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
04/28/2010
Last updated
10/17/2024
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