GLACIER DERMATOLOGY PC NPI 1407366545

NPI Information

  • NPI: 1407366545
  • Provider Name: GLACIER DERMATOLOGY PC
  • Classification: Dermatology - 207N00000X
  • Entity Type: Organization
  • Address: 40 FOUR MILE DR STE 7
    KALISPELL, MT
    ZIP 59901
  • Phone: (406) 314-6336

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NPI Details

GLACIER DERMATOLOGY PC is a dermatology in Kalispell, MT. 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. GLACIER DERMATOLOGY PC NPI is 1407366545. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

40 FOUR MILE DR STE 7
KALISPELL, MT
ZIP 59901-655
Phone: (406) 314-6336

The provider's authorized official is Sylvia A Owen .
The authorized official title is Physician/owner and has the following contact phone number (406) 314-6336.

The enumeration date for this NPI number is 10/3/2017 and was last updated on 12/12/2017.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207N00000XDermatologyNo
2207N00000XDermatology10806MONTANAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10143741MEDICAIDMONTANA

What is NPI?

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This page was last updated on: 11/21/2025

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