Premier Dermatologic Surgery, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

30619 Issued in KS

Legal business name

PREMIER DERMATOLOGIC SURGERY, PA

Practice address

12200 W 106TH St
Suite 210
Overland Park, KS 66215-2300

Phone

(913) 327-1117

Fax

(913) 327-1119

NPI assigned

Jul 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth A Spenceri, M.D.

Title

Medical Director

Phone

(913) 327-1117

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1487671384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 W 106TH ST",
            "address_2": "SUITE 210",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662152300",
            "telephone_number": "913-327-1117",
            "fax_number": "913-327-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 W 106TH ST",
            "address_2": "SUITE 210",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662152300",
            "telephone_number": "913-327-1117",
            "fax_number": "913-327-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DERMATOLOGIC SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "SPENCERI",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "913-327-1117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "KS",
            "license": "30619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Dermatology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.