MEDICARE: RATIONAL DERMATOLOGY, PC

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	207N00000X	Dermatology Physician	48132	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356334965	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1548592363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RATIONAL DERMATOLOGY, PC

Provider Business Mailing Address
First Line	:	8580 SCARBOROUGH DR
Second Line	:	SUITE 225
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7583
Country	:	US
Telephone Number	:	719-531-5400
Fax Number	:	719-531-9545

Provider Business Practice Location Address
First Line	:	8580 SCARBOROUGH DR
Second Line	:	SUITE 225
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7586
Country	:	US
Telephone Number	:	719-531-5400
Fax Number	:	719-531-9545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REAGAN ANDERSON
Credential	:	DO
Telephone Number	:	719-246-4582

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	06/03/2010

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