Provider Demographics
NPI:1467628404
Name:TWIN PEAKS DERMATOLOGY, PC
Entity Type:Organization
Organization Name:TWIN PEAKS DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF TWIN PEAKS DERMATOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-485-8913
Mailing Address - Street 1:205 S MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1716
Mailing Address - Country:US
Mailing Address - Phone:303-485-8913
Mailing Address - Fax:303-485-8914
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1716
Practice Address - Country:US
Practice Address - Phone:303-485-8913
Practice Address - Fax:303-485-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty