Healthcare Provider Details

I. General information

NPI: 1922562743
Provider Name (Legal Business Name): CENTRAL IOWA DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 62ND CT
WEST DES MOINES IA
50266-8602
US

IV. Provider business mailing address

230 62ND CT
WEST DES MOINES IA
50266-8602
US

V. Phone/Fax

Practice location:
  • Phone: 515-726-3376
  • Fax: 515-446-9707
Mailing address:
  • Phone: 515-726-3376
  • Fax: 515-446-9707

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
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC ALLEN HARLAN
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 319-321-3515