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General NPI Number Information
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NPI Number | 1851251706
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CENTER OF STEAMBOAT SPRINGS, LLC A PROFESSIONAL LLC
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1000 GRANBY PARK DR S
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City | GRANBY
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State | CO
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Zip | 80446-5304
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Country | US
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Telephone | 970-871-4811
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Fax |
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Provider Business Mailing Address
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Address Line | 940 CENTRAL PARK DR STE 210
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City | STEAMBOAT SPRINGS
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State | CO
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Zip | 80487-8853
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Country | US
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Telephone | 970-871-4811
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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 | MARLA JACKSON
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Credential |
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Telephone | 970-871-4811
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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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