Provider Demographics
NPI:1932479961
Name:PEAK DERMATOLOGY PROFESSIONAL LLC
Entity Type:Organization
Organization Name:PEAK DERMATOLOGY PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-246-4451
Mailing Address - Street 1:2009 W LITTLETON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2024
Mailing Address - Country:US
Mailing Address - Phone:303-221-4448
Mailing Address - Fax:720-287-6235
Practice Address - Street 1:2009 W LITTLETON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2024
Practice Address - Country:US
Practice Address - Phone:303-246-4451
Practice Address - Fax:720-287-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46029207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty