MEDICARE: RAPID CITY DERMATOLOGY & MOHS PLLC

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
1	207ND0101X	MOHS-Micrographic Surgery Physician

General Provider Information

NPI Number	:	1518832013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPID CITY DERMATOLOGY & MOHS PLLC

Provider Business Mailing Address
First Line	:	705 COLUMBUS ST FL 2
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 COLUMBUS ST FL 2
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3623
Country	:	US
Telephone Number	:	941-315-1099
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAREN GAUL
Credential	:	DO
Telephone Number	:	808-352-4425

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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