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General NPI Number Information
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NPI Number | 1902400690
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Entity Type | Organization
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Legal Business Name | BILLINGS DERMATOLOGY PC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 1106 BIG HORN AVE
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City | WORLAND
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State | WY
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Zip | 82401-2803
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Country | US
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Telephone | 406-294-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 BIG HORN AVE
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City | WORLAND
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State | WY
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Zip | 82401-2803
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Country | US
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Telephone | 406-294-9515
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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 | MICHELLE QUALLS
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Credential |
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Telephone | 406-294-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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