Basic Information
| Provider Information | |||||||||
| NPI: | 1336519248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED DERMATOLOGY OF DENVER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 CLINT MOORE RD | ||||||||
| Address2: | SUITE 226 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613142000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7476 WATERSIDE LOOP RD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | DENVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280377679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048225433 | ||||||||
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| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | QUEEN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5613142000 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.