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General NPI Number Information
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NPI Number | 1518929694
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CLINIC, PA
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1114 CORNELIA RD
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City | ANDERSON
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State | SC
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Zip | 29621-3317
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Country | US
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Telephone | 864-225-1656
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Fax | 864-225-1658
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Provider Business Mailing Address
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Address Line | 1114 CORNELIA RD
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City | ANDERSON
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State | SC
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Zip | 29621-3317
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Country | US
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Telephone | 864-225-1656
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Fax | 864-225-1658
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RICHARD PAUL STURTZ
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Credential | MD
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Telephone | 864-225-1656
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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 | 11493
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License Number State | SC
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