Provider Demographics
NPI:1790736353
Name:DERMATOLOGY, PC
Entity Type:Organization
Organization Name:DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:I
Authorized Official - Last Name:CEILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-241-2000
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2000
Mailing Address - Fax:515-241-2000
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2000
Practice Address - Fax:515-241-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0999Medicare ID - Type Unspecified