Provider Demographics
NPI:1033500806
Name:BAINBRIDGE SKIN SURGERY AND CONSULTATIVE DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:BAINBRIDGE SKIN SURGERY AND CONSULTATIVE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-842-5666
Mailing Address - Street 1:271 WYATT WAY NE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2873
Mailing Address - Country:US
Mailing Address - Phone:206-842-5666
Mailing Address - Fax:425-742-8516
Practice Address - Street 1:271 WYATT WAY NE
Practice Address - Street 2:SUITE 108
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2873
Practice Address - Country:US
Practice Address - Phone:206-842-5666
Practice Address - Fax:425-742-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46124207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty