Provider Demographics
NPI:1407363971
Name:PURE DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:PURE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CERA HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-725-7592
Mailing Address - Street 1:501 S CHERRY ST STE 310
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1325
Mailing Address - Country:US
Mailing Address - Phone:303-333-7873
Mailing Address - Fax:
Practice Address - Street 1:501 S CHERRY ST STE 310
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1325
Practice Address - Country:US
Practice Address - Phone:303-333-7873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48901207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty