| NPI | 1124263546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVAN G LEWIS Owner 401-525-8084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR-45901) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO DR-45901) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CO DR-45901) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: CO DR-45901) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CO DR-45901) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CO DR-45901) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: CO DR-45901) | |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2008-12-15 |