Healthcare Provider Details

I. General information

NPI: 1730188160
Provider Name (Legal Business Name): GREATER DES MOINES DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 128TH ST NW 128TH STREET
URBANDALE IA
50323-1816
US

IV. Provider business mailing address

2424 128TH ST NW 128TH STREET
URBANDALE IA
50323-1816
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-8676
  • Fax: 515-243-0487
Mailing address:
  • Phone: 515-243-8676
  • Fax: 515-243-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number33182
License Number StateIA

VIII. Authorized Official

Name: DR. TIMOTHY GARTH ABRAHAMSON
Title or Position: CEO
Credential: M.D.
Phone: 515-243-8676