Organization
PHOTODERMIC SKIN THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG WREGGE (OWNER)
(317) 283-8113
Entity
Organization
Contact information
Practice address
3833 N MERIDIAN ST STE 10, INDIANAPOLIS, IN 46208-4001
(317) 926-4687
Mailing address
3833 N MERIDIAN ST STE 10, INDIANAPOLIS, IN 46208-4001
(317) 926-4687
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Enumeration date
04/09/2008
Last updated
04/09/2008
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