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General NPI Number Information
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NPI Number | 1134467962
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CLINIC PLLC
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 7707 SE 27TH ST SUITE 104
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2844
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Country | US
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Telephone | 206-852-4339
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Fax |
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Provider Business Mailing Address
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Address Line | 7707 SE 27TH ST SUITE 104
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2844
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Country | US
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Telephone | 206-852-4339
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE J GARTON
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Credential | MD
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Telephone | 206-852-4339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 60078978
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License Number State |
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