Basic Information
Provider Information
NPI: 1053449306
EntityType: 2
ReplacementNPI:  
OrganizationName: DERMATOLOGY SPECIALISTS OF BOULDER, PC
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Mailing Information
Address1: 1056 S 88TH ST
Address2:  
City: LOUISVILLE
State: CO
PostalCode: 800279460
CountryCode: US
TelephoneNumber: 3034426647
FaxNumber: 3034422696
Practice Location
Address1: 1056 S 88TH ST
Address2:  
City: LOUISVILLE
State: CO
PostalCode: 800279460
CountryCode: US
TelephoneNumber: 3034426647
FaxNumber: 3034422696
Other Information
ProviderEnumerationDate: 03/01/2007
LastUpdateDate: 06/02/2022
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AuthorizedOfficialLastName: ALLEN
AuthorizedOfficialFirstName: SHAWN
AuthorizedOfficialMiddleName: B
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3034426647
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 06/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X43816CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansDermatology 
207ND0900X43816CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
207NS0135X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
207ND0101X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery

No ID Information.


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