Healthcare Provider Details

I. General information

NPI: 1134698103
Provider Name (Legal Business Name): GLOBAL DERMATOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N TAYLOR ST
GUNNISON CO
81230-2208
US

IV. Provider business mailing address

711 N TAYLOR ST
GUNNISON CO
81230-2208
US

V. Phone/Fax

Practice location:
  • Phone: 970-641-3927
  • Fax: 833-428-9482
Mailing address:
  • Phone: 719-505-0105
  • Fax: 833-428-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NICKOLAS E POULOS
Title or Position: PRESIDENT
Credential: DO
Phone: 719-505-0105