Healthcare Provider Details

I. General information

NPI: 1831507805
Provider Name (Legal Business Name): INTEGRATED DERMATOLOGY OF MONTROSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 WOLVERINE DR SUITE F
MONTROSE CO
81401-4965
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-7444
  • Fax: 970-252-3446
Mailing address:
  • Phone: 561-314-2000
  • 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 Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ADAM S. PLOTKIN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 561-314-2000