Provider Demographics
NPI:1336519248
Name:INTEGRATED DERMATOLOGY OF DENVER, PLLC
Entity Type:Organization
Organization Name:INTEGRATED DERMATOLOGY OF DENVER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-314-2000
Mailing Address - Street 1:902 CLINT MOORE RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2800
Mailing Address - Country:US
Mailing Address - Phone:561-314-2000
Mailing Address - Fax:
Practice Address - Street 1:7476 WATERSIDE LOOP RD
Practice Address - Street 2:SUITE 600
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7679
Practice Address - Country:US
Practice Address - Phone:704-822-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty