Healthcare Provider Details

I. General information

NPI: 1902876998
Provider Name (Legal Business Name): ABERDEEN DERMATOLOGY CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S LLOYD ST
ABERDEEN SD
57401-4552
US

IV. Provider business mailing address

201 S LLOYD ST
ABERDEEN SD
57401-4552
US

V. Phone/Fax

Practice location:
  • Phone: 605-226-0560
  • Fax: 605-226-1653
Mailing address:
  • Phone: 605-226-0560
  • Fax: 605-226-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1205
License Number StateSD

VIII. Authorized Official

Name: DR. WARREN JOHN REDMOND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 605-226-0560