Provider Demographics
NPI:1467563148
Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY MED CENTER
Entity Type:Organization
Organization Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY MED CENTER
Other - Org Name:CONTOUR DERMATOLOGY AND COSMETIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIR AND VP
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-423-4043
Mailing Address - Street 1:42600 MIRAGE RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4127
Mailing Address - Country:US
Mailing Address - Phone:760-423-4000
Mailing Address - Fax:760-318-8103
Practice Address - Street 1:558 S PASEO DOROTEA STE 6
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1429
Practice Address - Country:US
Practice Address - Phone:760-423-4000
Practice Address - Fax:760-318-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35206Medicare UPIN
ZZZ23608ZMedicare ID - Type Unspecified