Healthcare Provider Details

I. General information

NPI: 1336177880
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVENUE BLDG B SUITE 303
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

505 NE 87TH AVENUE BLDG B SUITE 303
VANCOUVER WA
98664-1965
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-5267
  • Fax: 360-254-6089
Mailing address:
  • Phone: 360-254-5267
  • Fax: 360-254-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN M VIGELAND
Title or Position: PARTNER
Credential: MD
Phone: 360-254-5267