| NPI | 1891992624 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Doing Business As | PROVIDENCE MEDICAL GROUP DERMATOLOGIC SPECIALTIES |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207NS0135X Dermatology, Procedural Dermatology | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2024-06-13 |