Provider Demographics
NPI:1134298698
Name:REGIONAL DERMATOLOGY P.C.
Entity Type:Organization
Organization Name:REGIONAL DERMATOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAMBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:918-336-5454
Mailing Address - Street 1:501 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003
Mailing Address - Country:US
Mailing Address - Phone:918-336-5454
Mailing Address - Fax:918-336-4449
Practice Address - Street 1:501 E FRANK PHILLIPS BLVD
Practice Address - Street 2:STE 202
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003
Practice Address - Country:US
Practice Address - Phone:918-336-5454
Practice Address - Fax:918-336-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK-2149207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty