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General NPI Number Information
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NPI Number | 1598885295
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Entity Type | Organization
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Legal Business Name | BOULEVARD DERMATOLOGY P A
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 5520 COLLEGE BLVD SUITE 410
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1630
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Country | US
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Telephone | 913-451-5934
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Fax | 913-451-4716
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Provider Business Mailing Address
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Address Line | 5520 COLLEGE BLVD SUITE 410
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1630
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Country | US
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Telephone | 913-451-5934
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Fax | 913-451-4716
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | JANA KAY WOOD
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Credential |
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Telephone | 816-318-9400
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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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