| Organization Name: | DERMATOLOGY CENTER OF STEAMBOAT SPRINGS, LLC A PROFESSIONAL LLC |
| NPI Number: | 1215157029 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDRA L EIVINS (OWNER) |
| Mailing Address: | 940 Central Park Dr Suite 210 Steamboat Springs |
| State: | CO US |
| Postal Code: | 804878816 |
| Phone Number: | 9708714811 |
| Fax Number: | 9708794527 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 09/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 36567 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |