Bainbridge Skin Surgery and Consultative Dermatology PLLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

46124 Issued in WA

Legal business name

BAINBRIDGE SKIN SURGERY AND CONSULTATIVE DERMATOLOGY PLLC

Practice address

271 Wyatt Way NE
Suite 108
Bainbridge Island, WA 98110-2873

Phone

(206) 842-5666

Fax

(425) 742-8516

NPI assigned

Feb 13, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Duane C Whitaker, M.D.

Title

Owner

Phone

(206) 842-5666

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1033500806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 WYATT WAY NE",
            "address_2": "SUITE 108",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102873",
            "telephone_number": "206-842-5666",
            "fax_number": "425-742-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 WYATT WAY NE",
            "address_2": "SUITE 108",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102873",
            "telephone_number": "206-842-5666",
            "fax_number": "425-742-8516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAINBRIDGE SKIN SURGERY AND CONSULTATIVE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-842-5666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "WA",
            "license": "46124",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "WA",
            "license": "46124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bainbridge Island Physical Therapy, LLC
• Bainbridge Island School District
• Bainbridge Mental Health, PLLC
• Bainbridge Pediatric Therapy
• Bainbridge Pediatrics, PLLC
• Bainbridge Vision Inc PS
• Laura West Baker, LMHC
• Michelle Bale
• Lucija Banic
• Jillian Barry, OT

• MOHS-Micrographic Surgery Physician in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• MOHS-Micrographic Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.