Organization Name: | ISLAND COUNTY DERMATOLOGY, PLLC |
NPI Number: | 1144496613 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONALD RUSSELL JOHNSON (OWNER) |
Mailing Address: | 3110 Commercial Ave Ste 105 Anacortes |
State: | WA US |
Postal Code: | 982212762 |
Phone Number: | 3605880613 |
Fax Number: | |
NPI Enumeration Date: | 05/05/2008 |
NPI Last Update Date: | 11/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | MD00038058 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |