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General NPI Number Information
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NPI Number | 1417163635
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Entity Type | Organization
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Legal Business Name | SILVER FALLS DERMATOLOGY, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 11011 MERIDIAN AVE N SUITE 102
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City | SEATTLE
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State | WA
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Zip | 98133-8967
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Country | US
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Telephone | 206-859-5777
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Fax | 206-859-5776
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Provider Business Mailing Address
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Address Line | PO BOX 741825
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City | LOS ANGELES
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State | CA
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Zip | 90074-1825
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Country | US
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Telephone | 206-859-5777
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Fax | 206-859-5776
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MALISSA KOBBEVIK
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Credential |
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Telephone | 360-375-2038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology 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 | 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 #3
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | MD00042289
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License Number State | WA
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