Dermatology and Laser Surgery Associates of Fort Wayne P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY AND LASER SURGERY ASSOCIATES OF FORT WAYNE P.C.

Practice address

10620 Corporate Dr
Suite a
Fort Wayne, IN 46845-1711

Phone

(260) 423-2567

Fax

(260) 482-7445

NPI assigned

Oct 24, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Alan Gilbert, M.D.

Title

Owner

Phone

(260) 423-2567

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194566400000",
    "number": "1043499221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10620 CORPORATE DR",
            "address_2": "SUITE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451711",
            "telephone_number": "260-423-2567",
            "fax_number": "260-482-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10620 CORPORATE DR",
            "address_2": "SUITE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451711",
            "telephone_number": "260-423-2567",
            "fax_number": "260-482-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND LASER SURGERY ASSOCIATES OF FORT WAYNE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2007-11-09",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-423-2567",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carry E Depold, PA C
• Ida Marie Depree, MAMFT
• Dera, Inc
• Karen Derickson
• Keith J. Derickson, MD
• Dennis M Derosa, MD
• Diana Derrer, OTD, OTR/L
• Deanna Derry, LCSW
• Vishrut Desai, PHARMD
• Julia Desanto, RN

• Dermatology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; 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.