Provider Demographics
NPI:1629032404
Name:DERMATOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:319-236-3444
Mailing Address - Street 1:3812 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5200
Mailing Address - Country:US
Mailing Address - Phone:319-236-3444
Mailing Address - Fax:319-236-0257
Practice Address - Street 1:220 SOUTHBROOK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5802
Practice Address - Country:US
Practice Address - Phone:319-236-3444
Practice Address - Fax:319-236-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151712Medicaid
IA0151712Medicaid