| Dermatology And Endocrinology Llc | |
|
1925 E Orman Ave Ste 115 Pueblo CO 81004-3500 | |
| (719) 564-4500 | |
| (719) 564-0304 |
| Full Name | Dermatology And Endocrinology Llc |
|---|---|
| Speciality | Dermatology |
| Location | 1925 E Orman Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Kim K Dernovsek (OWNER) |
| Authorized Official Contact | 7195644500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dermatology And Endocrinology Llc 1925 E Orman Ave Ste 115 Pueblo CO 81004-3537 Ph: (719) 564-4500 | Dermatology And Endocrinology Llc 1925 E Orman Ave Ste 115 Pueblo CO 81004-3500 Ph: (719) 564-4500 |
| NPI Number | 1114999018 |
|---|---|
| Provider Enumeration Date | 02/03/2006 |
| Last Update Date | 01/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114999018 | NPI | - | NPPES |
| 96378352 | Medicaid | CO | |
| 1114999018 | Other | CO | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 26084 (Colorado) | Secondary |
| 207N00000X | Dermatology | 26083 (Colorado) | Primary |
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