Healthcare Provider Details

I. General information

NPI: 1881660751
Provider Name (Legal Business Name): ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 N HUTCHINSON RD
SPOKANE VALLEY WA
99212-2444
US

IV. Provider business mailing address

1807 N HUTCHINSON RD
SPOKANE VALLEY WA
99212-2444
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-7414
  • Fax: 509-624-0763
Mailing address:
  • Phone: 509-456-7414
  • Fax: 509-624-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number207ND0900X
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number207NS0135X
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number207N00000X
License Number StateWA

VIII. Authorized Official

Name: JOEL K SEARS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 509-456-7414