Provider Demographics
NPI:1649215302
Name:AYLESWORTH DERMATOLOGY SC
Entity Type:Organization
Organization Name:AYLESWORTH DERMATOLOGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-226-9232
Mailing Address - Street 1:550 E TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2894
Mailing Address - Country:US
Mailing Address - Phone:715-226-9232
Mailing Address - Fax:715-862-7646
Practice Address - Street 1:550 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2894
Practice Address - Country:US
Practice Address - Phone:715-226-9232
Practice Address - Fax:949-862-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty