Provider Demographics
NPI:1770275323
Name:SKIN CANCER AND DERMATOLOGY CENTER OF COLORADO SPRINGS, P.C.
Entity type:Organization
Organization Name:SKIN CANCER AND DERMATOLOGY CENTER OF COLORADO SPRINGS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-574-0310
Mailing Address - Street 1:1975 RESEARCH PKWY STE 165
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1026
Mailing Address - Country:US
Mailing Address - Phone:719-574-0310
Mailing Address - Fax:719-574-6574
Practice Address - Street 1:509 W 17TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2622
Practice Address - Country:US
Practice Address - Phone:719-564-5544
Practice Address - Fax:719-564-2246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKIN CANCER AND DERMATOLOGY CENTER OF COLORADO SPRINGS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty