Healthcare Provider Details

I. General information

NPI: 1306968797
Provider Name (Legal Business Name): DERMATOLOGY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 MISSION HILL WAY
COLORADO SPGS CO
80921-2671
US

IV. Provider business mailing address

685 MISSION HILL WAY
COLORADO SPGS CO
80921-2671
US

V. Phone/Fax

Practice location:
  • Phone: 719-488-8724
  • Fax: 719-531-9545
Mailing address:
  • Phone: 719-488-8724
  • Fax: 719-531-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number22263
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number22263
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22263
License Number StateCO

VIII. Authorized Official

Name: CHARLES G HUGHES
Title or Position: PRESIDENT
Credential: D. O.
Phone: 719-488-8724