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Physicians Dermatology Procedural Dermatology

Provider NPI: 1962481044

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
2805 5TH ST 100 RAPID CITY, SD 57701-7306 US
Tel: 605-755-5700  Fax: 605-755-3691

Business Mailing Address:
Tel: 262-896-6350  Fax: 262-896-6351

NPI Information:
NPI: 1962481044
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Procedural Dermatology

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207NS0135X





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