| NPI | 1821856303 |
|---|---|
| Former Legal Business Name | ALTITUDE DERMATOLOGY, PC |
| Entity Type | Organization |
| Authorized Contact | BRAD BAACK Authorized Rep 970-217-8817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-09-30 |