53D1038865 CLIA NUMBER - WESTERN WYOMING DERMATOLOGY-ADVANCED DERMATOLOGY &

Laboratory Demographics

  • CLIA Code: 53D1038865
  • Facility Name: WESTERN WYOMING DERMATOLOGY-ADVANCED DERMATOLOGY &
  • Facility Address: 250 VERONICA LN STA 201
    JACKSON, WY
    ZIP 83001
  • Facility Phone: 407 284-3407
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: AFTON C. COBB
  • NPI Number: 1578633988
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 53D1038865
LAB Type Physician Office
Facility Name WESTERN WYOMING DERMATOLOGY-ADVANCED DERMATOLOGY &
Street 250 VERONICA LN STA 201
City JACKSON
State WY
ZIP 83001
Phone 407 284-3407
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/28/2024
Certificate Expiration Date 11/27/2026
Facility Type Physician Office
Lab Director AFTON C. COBB

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This page was last updated on: 9/29/2025