Waymore Shade LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

WAYMORE SHADE LLC

Practice address

451 S Main St Ste 1
Springville, UT 84663-2293

Phone

(801) 805-4744

NPI assigned

Apr 23, 2019

Organization subpart

No

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

Authorized official

Name

Isaac Bryan, DO

Title

Dermatologist

Phone

(801) 805-4744

Specialties & licenses 1

Addresses

Other names 1

• Summit Dermatology Doing business as

Locations

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1043874332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 S MAIN ST STE 1",
            "city": "SPRINGVILLE",
            "state": "UT",
            "postal_code": "846632293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 S MAIN ST STE 1",
            "city": "SPRINGVILLE",
            "state": "UT",
            "postal_code": "846632293",
            "telephone_number": "801-805-4744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYMORE SHADE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_title_or_position": "DERMATOLOGIST",
        "authorized_official_telephone_number": "801-805-4744",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Springville, UT
• Providers in Springville, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.