Provider Demographics
NPI:1225295199
Name:ADVANCED ALPINE DERMATOLOGY PROF LLC
Entity Type:Organization
Organization Name:ADVANCED ALPINE DERMATOLOGY PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-449-3500
Mailing Address - Street 1:1136 ALPINE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3405
Mailing Address - Country:US
Mailing Address - Phone:303-449-3500
Mailing Address - Fax:
Practice Address - Street 1:1136 ALPINE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3405
Practice Address - Country:US
Practice Address - Phone:303-449-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42483207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98428721Medicaid
COI23498Medicare UPIN
COC801116Medicare PIN