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General NPI Number Information
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NPI Number | 1134698103
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Entity Type | Organization
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Legal Business Name | GLOBAL DERMATOLOGY, INC.
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 711 N TAYLOR ST
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City | GUNNISON
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State | CO
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Zip | 81230-2208
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Country | US
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Telephone | 970-641-3927
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Fax | 833-428-9482
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Provider Business Mailing Address
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Address Line | 711 N TAYLOR ST
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City | GUNNISON
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State | CO
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Zip | 81230-2208
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Country | US
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Telephone | 719-505-0105
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Fax | 833-428-9482
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICKOLAS E POULOS
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Credential | DO
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Telephone | 719-505-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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