Basic Information
| Provider Information | |||||||||
| NPI: | 1992824197 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENVER SKIN CLINIC, P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3770 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801341440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038057686 | ||||||||
| FaxNumber: | 3038057732 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 E 18TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802061205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033227789 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 02/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAVARD | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3033227789 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.