Healthcare Provider Details

I. General information

NPI: 1427569243
Provider Name (Legal Business Name): CLARITY DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 LIMELIGHT AVENUE SUITE 205
CASTLE ROCK CO
80109-8034
US

IV. Provider business mailing address

4350 LIMELIGHT AVENUE SUITE 205
CASTLE ROCK CO
80109-8034
US

V. Phone/Fax

Practice location:
  • Phone: 720-686-7546
  • Fax: 720-686-7544
Mailing address:
  • Phone: 720-686-7546
  • Fax: 720-686-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: JAMES DANIEL JENSEN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 720-686-7546