Provider Demographics
NPI:1063502227
Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY MEDICAL CENTER
Entity Type:Organization
Organization Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY MEDICAL CENTER
Other - Org Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-423-4043
Mailing Address - Street 1:42600 MIRAGE RD STE A1
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4127
Mailing Address - Country:US
Mailing Address - Phone:760-423-4000
Mailing Address - Fax:760-318-8103
Practice Address - Street 1:42600 MIRAGE RD
Practice Address - Street 2:SUITE A1
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4127
Practice Address - Country:US
Practice Address - Phone:760-416-6971
Practice Address - Fax:760-318-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207ND0101X, 207NS0135X
CAA70216207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ58523Medicare UPIN
CAZZZ23608ZMedicare ID - Type UnspecifiedGROUP ID
CAZZZ03309ZMedicare ID - Type UnspecifiedELAINE PPIN
CA070017415Medicare ID - Type UnspecifiedRAILROAD MEDICARE PI
CAG35206Medicare UPIN
CA00A702160Medicare ID - Type UnspecifiedJOCHEN PPIN