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JORDAN VALLEY DERMATOLOGY NPI 1073954913


NPI Information

NPI: 1073954913
Provider Name: JORDAN VALLEY DERMATOLOGY

Former Legal Business Name: JORDAN VALLEY DERMATOLOGY

Classification: Specialist - 174400000X
Entity Type: Organization
Address:
428 S DURBIN ST STE 103
CASPER, WY
ZIP 82601
Phone: (307) 234-0003
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JORDAN VALLEY DERMATOLOGY is a specialist in Casper, WY. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. JORDAN VALLEY DERMATOLOGY NPI is 1073954913. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Jordan Valley Dermatology.

The provider's business location address is:

428 S DURBIN ST STE 103
CASPER, WY
ZIP 82601-829
Phone: (307) 234-0003
Fax: (307) 265-6575

The provider's authorized official is Virginia Louise Tubbs .
The authorized official title is Owner and has the following contact phone number (307) 265-2936.

The enumeration date for this NPI number is 7/8/2013 and was last updated on 6/21/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist8624096-4405UTAHYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.