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General NPI Number Information
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NPI Number | 1558853846
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Entity Type | Organization
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Legal Business Name | CROSSROADS DERMATOLOGY LLC
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 2350 17TH AVE STE 100
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City | LONGMONT
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State | CO
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Zip | 80503-1738
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Country | US
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Telephone | 720-204-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 TURIN DR
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City | LONGMONT
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State | CO
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Zip | 80503-2717
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Country | US
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Telephone | 813-504-6273
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SARAH MARIE BAIR
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Credential | MD
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Telephone | 813-504-6273
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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 | 48408
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License Number State | CO
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