1285792788 NPI number — DERMATOLOGY AND DERMATOLOGIC SURGERY CENTER, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285792788 NPI number — DERMATOLOGY AND DERMATOLOGIC SURGERY CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGY AND DERMATOLOGIC SURGERY CENTER, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285792788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8131 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIVE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50325-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-225-8180
Provider Business Mailing Address Fax Number:
515-225-2041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8131 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-225-8180
Provider Business Practice Location Address Fax Number:
515-225-2041
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNOKE
Authorized Official First Name:
DEE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
515-225-8180

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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