Provider Demographics
NPI:1043085020
Name:WYCO DERM LLC
Entity Type:Organization
Organization Name:WYCO DERM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-635-8299
Mailing Address - Street 1:2112 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3830
Mailing Address - Country:US
Mailing Address - Phone:307-635-8299
Mailing Address - Fax:307-635-6984
Practice Address - Street 1:8305 WELLINGTON BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-2399
Practice Address - Country:US
Practice Address - Phone:307-635-8299
Practice Address - Fax:307-635-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty