Provider Demographics
NPI:1659793180
Name:DERMSPECTRA, LLC
Entity Type:Organization
Organization Name:DERMSPECTRA, LLC
Other - Org Name:DERMSPECTRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-332-3644
Mailing Address - Street 1:2601 N CAMPBELL AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3163
Mailing Address - Country:US
Mailing Address - Phone:520-332-3644
Mailing Address - Fax:
Practice Address - Street 1:2601 N CAMPBELL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3163
Practice Address - Country:US
Practice Address - Phone:520-332-3644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory