Provider Demographics
NPI:1023360625
Name:LINDA WOODSON DERMATOLOGY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LINDA WOODSON DERMATOLOGY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-561-8741
Mailing Address - Street 1:2800 N TENAYA WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1100
Mailing Address - Country:US
Mailing Address - Phone:702-561-8741
Mailing Address - Fax:702-307-5480
Practice Address - Street 1:2800 N TENAYA WAY STE 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1100
Practice Address - Country:US
Practice Address - Phone:702-561-8741
Practice Address - Fax:702-307-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7012207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF12358Medicare UPIN