Provider Demographics
NPI:1922562743
Name:CENTRAL IOWA DERMATOLOGY LLC
Entity Type:Organization
Organization Name:CENTRAL IOWA DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-321-3515
Mailing Address - Street 1:230 62ND CT
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8602
Mailing Address - Country:US
Mailing Address - Phone:515-726-3376
Mailing Address - Fax:515-446-9707
Practice Address - Street 1:230 62ND CT
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8602
Practice Address - Country:US
Practice Address - Phone:515-726-3376
Practice Address - Fax:515-446-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty