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General NPI Number Information
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NPI Number | 1487671384
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Entity Type | Organization
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Legal Business Name | PREMIER DERMATOLOGIC SURGERY, PA
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 12200 W 106TH ST SUITE 210
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City | OVERLAND PARK
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State | KS
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Zip | 66215-2300
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Country | US
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Telephone | 913-327-1117
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Fax | 913-327-1119
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Provider Business Mailing Address
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Address Line | 12200 W 106TH ST SUITE 210
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City | OVERLAND PARK
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State | KS
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Zip | 66215-2300
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Country | US
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Telephone | 913-327-1117
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Fax | 913-327-1119
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ELIZABETH A SPENCERI
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Credential | M.D.
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Telephone | 913-327-1117
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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 | 30619
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License Number State | KS
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