Dermatology and Endocrinology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

26083 Issued in CO

Legal business name

DERMATOLOGY AND ENDOCRINOLOGY LLC

Practice address

1925 E Orman Ave
Ste 115
Pueblo, CO 81004-3500

Phone

(719) 564-4500

Fax

(719) 564-0304

NPI assigned

Feb 3, 2006

Last updated

Jan 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kim K Dernovsek, MDNPI 1497728786

Title

Owner

Phone

(719) 564-4500

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kim K Dernovsek, MD

  • Dermatology Physician
  • Pueblo, CO
  • NPI 1497728786
  Authorized official Same address or phone

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452470400000",
    "number": "1114999018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 E ORMAN AVE",
            "address_2": "STE 115",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043537",
            "telephone_number": "719-564-4500",
            "fax_number": "719-564-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 E ORMAN AVE",
            "address_2": "STE 115",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043500",
            "telephone_number": "719-564-4500",
            "fax_number": "719-564-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND ENDOCRINOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-03",
        "last_updated": "2016-01-11",
        "status": "A",
        "authorized_official_last_name": "DERNOVSEK",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-564-4500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "26083",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CO",
            "license": "26084",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "96378352",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "1114999018",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janise T Denton, D.O.
• Denver Vamc
• Denver Vamc
• Department of Veterans Affairs
• John Robert Dequardo, M.D.
• Kenneth D Dernovsek, MD
• Kim K Dernovsek, MD
• Derose Children's Dental Clinic, PC
• Michael Anthony Derose
• Katherine R Derossett, NP

• Dermatology Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; 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.