Provider Demographics
NPI:1821856303
Name:ALTITUDE DERMATOLOGY, PC
Entity Type:Organization
Organization Name:ALTITUDE DERMATOLOGY, PC
Other - Org Name:ALTITUDE DERMATOLOGY, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYERSDOERFER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:970-402-2560
Mailing Address - Street 1:83 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-7604
Mailing Address - Country:US
Mailing Address - Phone:970-402-2560
Mailing Address - Fax:
Practice Address - Street 1:4795 LARIMER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9021
Practice Address - Country:US
Practice Address - Phone:970-402-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty