Provider Demographics
NPI:1871634790
Name:BOULDER DERMATOLOGY CLINIC, PC
Entity Type:Organization
Organization Name:BOULDER DERMATOLOGY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-666-5261
Mailing Address - Street 1:400 S MCCASLIN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9731
Mailing Address - Country:US
Mailing Address - Phone:303-666-5261
Mailing Address - Fax:303-604-6062
Practice Address - Street 1:400 S MCCASLIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9731
Practice Address - Country:US
Practice Address - Phone:303-666-5261
Practice Address - Fax:303-604-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF2208Medicare ID - Type UnspecifiedMEDICARE