| NPI | 1013538354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER GUST-ALLEN Revenue Cycle Manager 719-465-5643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207ND0900X Dermatology, Dermatopathology | |
| 207NP0225X Dermatology, Pediatric Dermatology | |
| 207NS0135X Dermatology, Procedural Dermatology | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery | |
| 208200000X Plastic Surgery | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2024-04-01 |