Healthcare Provider Details

I. General information

NPI: 1144697673
Provider Name (Legal Business Name): COLORADO DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 TIMBERLINE RD SUITE 140
HIGHLANDS RANCH CO
80130-5345
US

IV. Provider business mailing address

6660 TIMBERLINE RD SUITE 140
HIGHLANDS RANCH CO
80130-5345
US

V. Phone/Fax

Practice location:
  • Phone: 303-683-3235
  • Fax: 303-683-3236
Mailing address:
  • Phone: 303-683-3235
  • Fax: 303-683-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDR.0051289
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberDR.0051289
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberDR.0051289
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberDR.0051289
License Number StateCO

VIII. Authorized Official

Name: MS. TASHA DENHAM
Title or Position: PATIENT COORDINATOR
Credential:
Phone: 303-683-3235