Healthcare Provider Details

I. General information

NPI: 1881298560
Provider Name (Legal Business Name): BILLINGS DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2294 GRANT RD
BILLINGS MT
59102-7423
US

IV. Provider business mailing address

2294 GRANT RD
BILLINGS MT
59102-7423
US

V. Phone/Fax

Practice location:
  • Phone: 406-294-9515
  • Fax:
Mailing address:
  • Phone: 406-294-9515
  • 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: MICHELLE QUALLS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 406-294-9515