Provider Demographics
NPI:1659321826
Name:DERMATOLOGY AND LASER INSTITUTE OF COLORADO
Entity Type:Organization
Organization Name:DERMATOLOGY AND LASER INSTITUTE OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-344-5252
Mailing Address - Street 1:9695 S YOSEMITE ST
Mailing Address - Street 2:STE 175
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2888
Mailing Address - Country:US
Mailing Address - Phone:720-344-5252
Mailing Address - Fax:720-344-0296
Practice Address - Street 1:9695 S YOSEMITE ST
Practice Address - Street 2:STE 175
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2888
Practice Address - Country:US
Practice Address - Phone:720-344-5252
Practice Address - Fax:720-344-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38188207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC504738Medicare ID - Type UnspecifiedMEDICARE GROUP ID#