Healthcare Provider Details

I. General information

NPI: 1992938906
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF SOUTHWEST WASHINGTON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 E MILL PLAIN BLVD SUITE 400
VANCOUVER WA
98664-2059
US

IV. Provider business mailing address

8614 E MILL PLAIN BLVD SUITE 400
VANCOUVER WA
98664-2059
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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL H DATLOFF
Title or Position: OWNER
Credential: M.D.
Phone: 360-254-5267