Provider Demographics
NPI: | 1144582750 |
---|---|
Name: | ARBOR DERMATOLOGY |
Entity Type: | Organization |
Organization Name: | ARBOR DERMATOLOGY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KUMM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 719-623-2104 |
Mailing Address - Street 1: | 9480 BRIAR VILLAGE PT |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | COLORADO SPRINGS |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80920-7922 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 719-623-2104 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9480 BRIAR VILLAGE PT |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | COLORADO SPRINGS |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80920-7922 |
Practice Address - Country: | US |
Practice Address - Phone: | 719-623-2104 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-06-10 |
Last Update Date: | 2012-06-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 49833 | 207N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Single Specialty |