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SILVER FALLS DERMATOLOGY LLC NPI 1134375421


NPI Information

NPI: 1134375421
Provider Name: SILVER FALLS DERMATOLOGY, LLC

Former Legal Business Name: SILVER FALLS DERMATOLOGY, PC

Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 38D2110297

Address:
1793 13TH ST SE
SALEM, OR
ZIP 97302
Phone: (503) 362-8385
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SILVER FALLS DERMATOLOGY, LLC is a dermatology in Salem, OR. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. SILVER FALLS DERMATOLOGY, LLC NPI is 1134375421. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Silver Falls Dermatology, Pc.

The provider's business location address is:

1793 13TH ST SE
SALEM, OR
ZIP 97302-541
Phone: (503) 362-8385
Fax: (503) 362-8435

The provider's authorized official is Russell John Young .
The authorized official title is President and has the following contact phone number (503) 362-8385.

The CLIA number assigned to this NPI record is 38D2110297 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/18/2008 and was last updated on 3/12/2021.


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
1207N00000XDermatologyMD26178OREGONNo
2207ND0101XDermatologyMOHS-Micrographic SurgeryNo
3207ND0900XDermatologyDermatopathologyNo
4207NI0002XDermatologyClinical & Laboratory Dermatological ImmunologyNo
5207NS0135XDermatologyProcedural DermatologyNo
6363A00000XPhysician AssistantNo
7363L00000XNurse PractitionerNo
8207N00000XDermatologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1247588MEDICAIDOREGON

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: 4/28/2024

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