NPIMap

Organization Active NPI

Fife Dermatology, PC 1

Doing business as Surgical Dermatology and Laser Center

  • Dermatology Physician
  • Las Vegas, NV
National Provider Identifier
1619492378
Registry record updated Aug 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FIFE DERMATOLOGY, PC 1
Doing business as
Surgical Dermatology and Laser Center
Practice address
10080 West Alta Drive
Suite 120
Las Vegas, NV 89145-8651
Phone
(702) 255-6647
Fax
(702) 933-1444
NPI assigned
Aug 3, 2017
Last updated
Aug 3, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
FIFE DERMATOLOGY, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 3, 2017

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

Authorized official

Name
Mr. Douglas J. Fife, M.D.NPI 1225228034
Title
Ceo
Phone
(702) 255-6647

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

10080 West Alta Drive
Suite 120
Las Vegas, NV 89145-8651

Mailing address

10080 West Alta Drive
Suite 120
Las Vegas, NV 89145-8651
Phone (702) 255-6647

Other names 1

  • Surgical Dermatology and Laser Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fife Dermatology PC3 organizations share this tax ID, including this one
Part of
Fife Dermatology PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10080 Alta Dr
Ste 120
Las Vegas, NV 89145
Phone (702) 255-6647

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1501718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501718400000",
    "number": "1619492378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10080 WEST ALTA DRIVE",
            "address_2": "SUITE 120",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891458651",
            "telephone_number": "702-255-6647",
            "fax_number": "702-933-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10080 WEST ALTA DRIVE",
            "address_2": "SUITE 120",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891458651",
            "telephone_number": "702-255-6647",
            "fax_number": "702-933-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIFE DERMATOLOGY, PC 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIFE DERMATOLOGY, PC",
        "enumeration_date": "2017-08-03",
        "last_updated": "2017-08-03",
        "status": "A",
        "authorized_official_last_name": "FIFE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-255-6647",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgical Dermatology and Laser Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; 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.