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General NPI Number Information
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NPI Number | 1912262338
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ELECTRONIC CONSULTANTS, PROFESSIONAL LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 240 ELIZABETH ST SUITE A-1, #15
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City | ELIZABETH
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State | CO
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Zip | 80107-7537
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Country | US
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Telephone | 319-400-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 240 ELIZABETH ST SUITE H-1, #15
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City | ELIZABETH
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State | CO
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Zip | 80107-7537
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Country | US
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Telephone | 319-400-7260
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. THEODORE JAMES ALKOUSAKIS
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Credential | M.D.
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Telephone | 319-400-7260
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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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