Provider Demographics
NPI:1902876998
Name:ABERDEEN DERMATOLOGY CLINIC, LTD.
Entity Type:Organization
Organization Name:ABERDEEN DERMATOLOGY CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-226-0560
Mailing Address - Street 1:201 S LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4552
Mailing Address - Country:US
Mailing Address - Phone:605-226-0560
Mailing Address - Fax:605-226-1653
Practice Address - Street 1:201 S LLOYD ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4552
Practice Address - Country:US
Practice Address - Phone:605-226-0560
Practice Address - Fax:605-226-1653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty