Provider Demographics
NPI:1912103979
Name:DERMATOLOGY ASSOCIATES LLP
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES LLP
Other - Org Name:DRS PUHL AND BOYSEN LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOYSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-337-3177
Mailing Address - Street 1:501 12TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1774
Mailing Address - Country:US
Mailing Address - Phone:319-337-3177
Mailing Address - Fax:319-341-0024
Practice Address - Street 1:501 12TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1774
Practice Address - Country:US
Practice Address - Phone:319-337-3177
Practice Address - Fax:319-341-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207N00000X, 207ND0900X, 207NP0225X, 207NS0135X
207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0166470Medicaid
IA16647Medicare UPIN
IA16647Medicare PIN