Integrated Dermatology of Santa Fe, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTEGRATED DERMATOLOGY OF SANTA FE, LLC

Practice address

1850 Old Pecos TRL
Suite J
Santa Fe, NM 87505-4760

Phone

(505) 988-5120

NPI assigned

May 5, 2015

Last updated

May 5, 2015By 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

Gerry Christopher

Title

Authorized Official

Phone

(561) 314-2000

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Timothy Busch, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Santa Fe, NM
  • NPI 1346201704
  NPD (past)
• Edward David Wright, MD

  • Dermatopathology Physician
  • Rifle, CO
  • NPI 1235120080
  NPD (past)

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

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1316324841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 CLINT MOORE RD",
            "address_2": "SUITE 226",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334872800",
            "telephone_number": "561-314-2000",
            "fax_number": "561-431-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 OLD PECOS TRL",
            "address_2": "SUITE J",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054760",
            "telephone_number": "505-988-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED DERMATOLOGY OF SANTA FE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "CHRISTOPHER",
        "authorized_official_first_name": "GERRY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "561-314-2000"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Santa Fe, NM
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; 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.