NPIMap

Organization Active NPI

Intermountain Skin Cancer & Esthetics Center PC

  • Specialist
  • Ogden, UT
National Provider Identifier
1487687430
Registry record updated Jan 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
5316026-1205 Issued in UT
Legal business name
INTERMOUNTAIN SKIN CANCER & ESTHETICS CENTER PC
Practice address
3860 Jackson Ave Ste 2
Ogden, UT 84403-1997
Phone
(801) 627-0515
Fax
(801) 627-0517
NPI assigned
Jul 9, 2006
Last updated
Jan 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2016

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

Authorized official

Name
Dr. David Edgar Allen, M.D.NPI 1619995107
Title
Medical Doctor
Phone
(801) 627-0515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 159426-1205 UT
Specialist 174400000X 5316026-1205 UT Primary
Specialist 174400000X 323171-1206 UT

Addresses

Primary practice location

3860 Jackson Ave Ste 2
Ogden, UT 84403-1997

Mailing address

3860 Jackson Ave
Suite 2
Ogden, UT 84403-1956
Phone (801) 627-0515

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452124800000",
    "number": "1487687430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 JACKSON AVE",
            "address_2": "SUITE 2",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844031956",
            "telephone_number": "801-627-0515",
            "fax_number": "801-627-0517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 JACKSON AVE STE 2",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844031997",
            "telephone_number": "801-627-0515",
            "fax_number": "801-627-0517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN SKIN CANCER & ESTHETICS CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2016-01-07",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "EDGAR",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "801-627-0515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "UT",
            "license": "159426-1205",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "UT",
            "license": "5316026-1205",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "UT",
            "license": "323171-1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; 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.