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General NPI Number Information
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NPI Number | 1992938906
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF SOUTHWEST WASHINGTON, PLLC
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 8614 E MILL PLAIN BLVD SUITE 400
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City | VANCOUVER
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State | WA
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Zip | 98664-2059
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Country | US
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Telephone | 360-254-5267
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Fax | 360-254-6089
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Provider Business Mailing Address
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Address Line | 8614 E MILL PLAIN BLVD SUITE 400
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City | VANCOUVER
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State | WA
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Zip | 98664-2059
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Country | US
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Telephone | 360-254-5267
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Fax | 360-254-6089
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOEL H DATLOFF
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Credential | M.D.
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Telephone | 360-254-5267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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