Provider Demographics
NPI:1659167674
Name:PENINSULA DERMATOLOGY & LASER CLINIC PLLC
Entity type:Organization
Organization Name:PENINSULA DERMATOLOGY & LASER CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-851-7733
Mailing Address - Street 1:4700 POINT FOSDICK DR STE 219
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-851-7733
Mailing Address - Fax:253-514-6320
Practice Address - Street 1:4700 POINT FOSDICK DR STE 219
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-7733
Practice Address - Fax:253-514-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty