Organization
LARK DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL LEVY MD (MEDICAL DIRECTOR)
(253) 862-5257
Entity
Organization
Contact information
Practice address
21137 STATE ROUTE 410 E STE I, BONNEY LAKE, WA 98391-8775
(253) 862-5275
Mailing address
21137 STATE ROUTE 410 E STE I, BONNEY LAKE, WA 98391-8775
(253) 862-5275
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
07/10/2019
Last updated
01/21/2020
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