Dermatolgy & Dermatologic Surgery PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD0000013019 Issued in TN

Legal business name

DERMATOLGY & DERMATOLOGIC SURGERY PC

Practice address

1021 W Oakland Dr
Suite 102
Johnson City, TN 37604-0000

Phone

(423) 928-9014

Fax

(423) 928-3559

NPI assigned

Nov 8, 2006

Organization subpart

No

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

Authorized official

Name

Larry David Hudson, MDNPI 1679564835

Title

Dermatologist President

Phone

(423) 928-9014

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

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

• Larry David Hudson, MD

  • Dermatology Physician
  • Johnson City, TN
  • NPI 1679564835
  NPD Authorized official
• James Richard Risney, PA

  • Dermatology Physician
  • Johnson City, TN
  • NPI 1639160815
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427128511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE",
            "address_2": "SUITE 102",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042191",
            "telephone_number": "423-928-9014",
            "fax_number": "423-928-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND DR",
            "address_2": "SUITE 102",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376040000",
            "telephone_number": "423-928-9014",
            "fax_number": "423-928-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLGY & DERMATOLOGIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "DERMATOLOGIST PRESIDENT",
        "authorized_official_telephone_number": "423-928-9014",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TN",
            "license": "MD0000013019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0036521",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3701830",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN0101",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariel Denton, APN
• Chloe Denton, RBT
• Elizabeth Depasquale, DO
• Ashlie Katelyn Depew, LCSW
• Paul J Derden, MD
• David T Deroos, DO
• Margaret Claire Deroos, DO
• Angela D Deschner, FNP-BC
• Mitchell Deshazer
• Aniruddha Deshkulkarni, PHARMACIST

• Dermatology Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.