Provider Demographics
NPI:1144776238
Name:COLORADO DERMATOLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:COLORADO DERMATOLOGY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:LILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-884-6776
Mailing Address - Street 1:3609 S TIMBERLINE RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3430
Mailing Address - Country:US
Mailing Address - Phone:888-884-6776
Mailing Address - Fax:970-482-9948
Practice Address - Street 1:3609 S TIMBERLINE RD UNIT A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3430
Practice Address - Country:US
Practice Address - Phone:888-884-6776
Practice Address - Fax:970-482-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0047867207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty