| NPI | 1114999018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM K DERNOVSEK Owner 719-564-4500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 26083) |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: CO 26084) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2016-01-11 |