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NPI Code Detail

MEDICARE: ALPINE DERMATOLOGY LLC

MEDICARE: ALPINE DERMATOLOGY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1306623749
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALPINE DERMATOLOGY LLC
Provider Business Mailing Address
First Line : 1661 LUCERNE ST
Second Line :
City : MINDEN
State : NV
Zip : 89423-4381
Country : US
Telephone Number : 775-782-0700
Fax Number : 778-782-0500
Provider Business Practice Location Address
First Line : 1661 LUCERNE ST
Second Line :
City : MINDEN
State : NV
Zip : 89423-4381
Country : US
Telephone Number : 775-782-0700
Fax Number : 778-782-0500
Authorized Official
Title or Position : OFFICE MANAGER
Name : LISA ANN VANDIVER
Credential :
Telephone Number : 775-782-0700
Provider Enumeration Date : 09/11/2023
Last Update Date : 07/19/2024

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Directions to “ALPINE DERMATOLOGY LLC ” Practice Location

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