NPIMap

Organization Active NPI

Fort Collins Skin Clinic, P.C.

  • Dermatology Physician
  • Fort Collins, CO
National Provider Identifier
1619904943
Registry record updated Sep 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
39315 Issued in CO
Legal business name
FORT COLLINS SKIN CLINIC, P.C.
Practice address
1120 E Elizabeth St
Suite G-2
Fort Collins, CO 80524-4044
Phone
(970) 484-6303
Fax
(970) 484-6908
NPI assigned
Jun 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2009

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

Authorized official

Name
Dr. Brad Robin Baack, M.D.
Title
M.D.
Phone
(970) 484-6303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 39315 CO Primary

Addresses

Primary practice location

1120 E Elizabeth St
Suite G-2
Fort Collins, CO 80524-4044

Mailing address

1120 E Elizabeth St
Suite G-2
Fort Collins, CO 80524-4044
Phone (970) 484-6303

National Provider Directory

National Provider Directory

Locations

1120 E Elizabeth St
Bldg G
Fort Collins, CO 80524

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252022400000",
    "number": "1619904943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E ELIZABETH ST",
            "address_2": "SUITE G-2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244044",
            "telephone_number": "970-484-6303",
            "fax_number": "970-484-6908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E ELIZABETH ST",
            "address_2": "SUITE G-2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244044",
            "telephone_number": "970-484-6303",
            "fax_number": "970-484-6908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT COLLINS SKIN CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2009-09-04",
        "status": "A",
        "authorized_official_last_name": "BAACK",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "ROBIN",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "970-484-6303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "39315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; 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.