NPI 1114999018 · live from the CMS NPI Registry
Dermatology And Endocrinology LLC
Dermatology in Pueblo, CO. National Provider Identifier 1114999018, active.
NPI record
| NPI | 1114999018 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 1925 E Orman Ave, Ste 115, Pueblo, CO 81004 |
| Practice phone | 719-564-4500 |
| Enumerated | February 3, 2006 |
| Last updated | January 11, 2016 |
| Authorized official | Kim Dernovsek, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine, Endocrinology, Diabetes & Metabolism | 207RE0101X | 26084 (CO) |
| Dermatology primary | 207N00000X | 26083 (CO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.