Provider Demographics
NPI:1902041668
Name:CEDAR DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:CEDAR DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAND
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-586-6440
Mailing Address - Street 1:166 W 1325 N
Mailing Address - Street 2:#250
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7792
Mailing Address - Country:US
Mailing Address - Phone:435-586-6440
Mailing Address - Fax:435-865-1477
Practice Address - Street 1:166 W 1325 N
Practice Address - Street 2:#250
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7792
Practice Address - Country:US
Practice Address - Phone:435-586-6440
Practice Address - Fax:435-865-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6496037-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty