Healthcare Provider Details

I. General information

NPI: 1518666064
Provider Name (Legal Business Name): ON SITE DERMATOLOGY OF COLORADO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N TAYLOR ST
GUNNISON CO
81230-2208
US

IV. Provider business mailing address

4700 EXCHANGE CT SUITE 110
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ADAM PLOTKIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 561-314-2000