Active NPI
Rocky Mountain Dermatology Inc
- Dermatology Physician
- North Logan, UT
National Provider Identifier
1154527372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 295172-1205
- Legal business name
- ROCKY MOUNTAIN DERMATOLOGY INC
- Practice address
- 1760 N 200 E Ste 101
North Logan, UT 84341 - Phone
- (435) 787-0560
- Fax
- (435) 752-4673
- NPI assigned
- Jun 25, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert P Young, M.D.
- Title
- Owner
- Phone
- (435) 787-0560
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 295172-1205 | UT | Primary |
| Clinical & Laboratory Dermatological Immunology Physician | 207NI0002X | 295172-1205 | UT | |
| Pediatric Dermatology Physician | 207NP0225X | 295172-1205 | UT | |
| Procedural Dermatology Physician | 207NS0135X | 295172-1205 | UT |
Addresses
Primary practice location
1760 N 200 E Ste 101
North Logan, UT 84341
Mailing address
1760 N 200 E Ste 101
North Logan, UT 84341-1202
Phone (435) 787-0560
Other practice location 1
1030 Medical Dr Ste A
Brigham City, UT 84302-3276
Phone (801) 827-9100
Other practice location 2
434 E 5350 S Ste D
Washington Terrace, UT 84405-5417
Phone (801) 827-9100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080318000363 | UT | Part B Supplier - Clinic/Group Practice | 6002992906 |
Receives reassigned benefits from 18 practitioners Practice locations: Brigham City, UT; Marriott Slaterville, UT; North Logan, UT; Ogden, UT; Tremonton, UT |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D0948038 | Rocky Mountain Dermatology | Compliance | Sep 30, 2026 |
National Provider Directory
National Provider DirectoryLocations
5748 S 500 E
#B
Ogden, UT 84405
Phone (801) 827-9100
5748 S 500 E
Ste B
Ogden, UT 84405
5748 Adams Avenue Pkwy
Ste B
Washington Terrace, UT 84405
Phone (801) 827-9100
Practitioners & affiliated clinicians
Practitioners 22
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- MOHS-Micrographic Surgery Physician
- American Fork, UT
- NPI 1598128985
Dermatology, UT
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1154527372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1760 N 200 E STE 101",
"city": "NORTH LOGAN",
"state": "UT",
"postal_code": "843411202",
"telephone_number": "435-787-0560",
"fax_number": "435-752-4673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1760 N 200 E STE 101",
"city": "NORTH LOGAN",
"state": "UT",
"postal_code": "84341",
"telephone_number": "435-787-0560",
"fax_number": "435-752-4673"
}
],
"practiceLocations": [
{
"address_1": "1030 Medical Dr Ste A",
"address_purpose": "LOCATION",
"city": "Brigham City",
"state": "UT",
"postal_code": "843023276",
"country_code": "US",
"telephone_number": "801-827-9100",
"fax_number": "801-827-9110",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "434 E 5350 S Ste D",
"address_purpose": "LOCATION",
"city": "Washington Terrace",
"state": "UT",
"postal_code": "844055417",
"country_code": "US",
"telephone_number": "801-827-9100",
"fax_number": "801-827-9110",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "ROCKY MOUNTAIN DERMATOLOGY INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-25",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "YOUNG",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "435-787-0560",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "UT",
"license": "295172-1205",
"primary": true
},
{
"code": "207NI0002X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
"state": "UT",
"license": "295172-1205",
"primary": false
},
{
"code": "207NP0225X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Pediatric Dermatology",
"state": "UT",
"license": "295172-1205",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Procedural Dermatology",
"state": "UT",
"license": "295172-1205",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.