Provider Demographics
NPI:1891327185
Name:CLEAR CHOICE DERMATOLOGY
Entity Type:Organization
Organization Name:CLEAR CHOICE DERMATOLOGY
Other - Org Name:THE SKIN DOCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-316-6575
Mailing Address - Street 1:PO BOX 2430
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-8022
Mailing Address - Country:US
Mailing Address - Phone:541-316-6575
Mailing Address - Fax:541-210-8913
Practice Address - Street 1:1815 E 15TH ST STE B
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3309
Practice Address - Country:US
Practice Address - Phone:541-316-6575
Practice Address - Fax:541-210-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty