Organization
PILOT BUTTE DERMATOLOGY, L.C.
Active
Other names
South Valley Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLASS W. FORSHA M.D. (PRESIDENT)
(801) 569-1456
Entity
Organization
Contact information
Practice address
196 ARROWHEAD DR, SUITE 5, EVANSTON, WY 82930-8752
(877) 689-0005
(801) 565-7931
Mailing address
3570 W 9000 S, #220, WEST JORDAN, UT 84088-8869
(801) 569-1456
(801) 565-7931
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8010A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506808177021
—
UT
Enumeration date
02/25/2009
Last updated
03/25/2009
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