Provider Demographics
NPI:1902109887
Name:DERMATOLOGY PROFESSIONALS
Entity Type:Organization
Organization Name:DERMATOLOGY PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-344-6643
Mailing Address - Street 1:PO BOX 28150
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-8150
Mailing Address - Country:US
Mailing Address - Phone:503-344-6643
Mailing Address - Fax:503-296-2887
Practice Address - Street 1:2228 LLOYD CTR
Practice Address - Street 2:SUITE 0H303
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1311
Practice Address - Country:US
Practice Address - Phone:503-344-6643
Practice Address - Fax:503-296-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R157904Medicare PIN