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General NPI Number Information
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NPI Number | 1255390548
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY, P.A.
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 7300 FRANCE AVE SO SUITE 400
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City | EDINA
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State | MN
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Zip | 55435-4544
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Country | US
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Telephone | 952-374-5995
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Fax | 952-374-5997
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Provider Business Mailing Address
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Address Line | 7300 FRANCE AVE SO SUITE 400
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City | EDINA
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State | MN
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Zip | 55435-4544
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Country | US
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Telephone | 952-374-5995
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Fax | 952-374-5997
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARTHUR W IDE III
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Credential | M.D.
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Telephone | 952-374-5995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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