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Physicians Dermatology Dermatopathology

Provider NPI: 1811311590

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
4605 S OXBOW AVE APT 204  SIOUX FALLS, SD 57106-4134 US
Tel: 605-261-3632  Fax: --

Business Mailing Address:
4605 S OXBOW AVE APT 204  SIOUX FALLS, SD 57106-4134 US
Tel: 605-261-3632  Fax: --

NPI Information:
NPI: 1811311590
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207ND0900X





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