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General NPI Number Information
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NPI Number | 1699021386
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Entity Type | Organization
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Legal Business Name | MOUNTAINTOP DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 2465 RESEARCH PKWY SUITE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-1089
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Country | US
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Telephone | 719-265-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 2465 RESEARCH PKWY SUITE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-1089
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Country | US
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Telephone | 719-265-0100
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SUSIE J GARRETT
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Credential |
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Telephone | 719-265-0100
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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 | 06220576
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License Number State | CO
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