Protean Dermatology Consulting, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PROTEAN DERMATOLOGY CONSULTING, LLC

Practice address

360 SW Bond St Ste 310
Bend, OR 97702-3556

Phone

(855) 457-5593

NPI assigned

Nov 26, 2024

Organization subpart

No

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

Authorized official

Name

John E Jackson, MDNPI 1558653725

Title

Physician Owner

Phone

(855) 457-5593

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Eric Jackson, M.D.

  • Procedural Dermatology Physician
  • Fort Myers, FL
  • NPI 1558653725
  NPD Authorized official

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

{
    "created_epoch": "1732579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1326864059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 SW BOND ST STE 310",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023556",
            "telephone_number": "855-457-5593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SW BOND ST STE 310",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023556",
            "telephone_number": "855-457-5593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTEAN DERMATOLOGY CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-26",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "855-457-5593",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristyn Renee Prockish, PMHNP
• Professionals Choice Medical Supplies and Special Transport
• Program Design Concepts, Inc (New Leaf Academy)
• Promotion Physical Therapy
• Prosthetics by Lynda Inc.
• Sarah C Provencio
• Providence Health & Services - Oregon (Providence Medical Group)
• Jennifer Prull
• Brett Joseph Prunty, M.ED LPC CRC CADC II
• Chavonne Suzanne Pryor, RN

• Dermatology Physician in Bend, OR
• Providers in Bend, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.