Provider Demographics
NPI:1376645143
Name:DERMATOLOGY & LASER CENTER AT HARVARD PARK, PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY & LASER CENTER AT HARVARD PARK, PLLC
Other - Org Name:DERMATOLOGY & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-744-2704
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:STE 440
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7009
Mailing Address - Country:US
Mailing Address - Phone:303-744-2704
Mailing Address - Fax:303-744-3244
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:STE 440
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-744-2704
Practice Address - Fax:303-744-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCH4005OtherRR MEDICARE
CO87557011Medicaid
CODE635330OtherBCBS
COC339708Medicare ID - Type Unspecified