NPI 1972004455 · live from the CMS NPI Registry
Dermatology By Design LLC
Dermatology in Portland, OR. National Provider Identifier 1972004455, active.
NPI record
| NPI | 1972004455 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 1129 Nw 11th Ave, Portland, OR 97209 |
| Practice phone | 503-705-2331 |
| Mailing address | 949 Nw Overton St Unit 608, Portland, OR 97209 |
| Enumerated | February 21, 2018 |
| Last updated | February 21, 2018 |
| Authorized official | Omar Qutub, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology primary | 207N00000X | MD158125 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.