Dermatology & Laser Center of Fort Collins LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

27691 Issued in CO

Legal business name

DERMATOLOGY & LASER CENTER OF FORT COLLINS LLC

Practice address

1006 Centre Ave
Fort Collins, CO 80526-1849

Phone

(970) 482-9001

Fax

(970) 482-1411

NPI assigned

Jun 24, 2006

Organization subpart

No

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

Authorized official

Name

Samuel A Kornfeld

Title

Office Manager

Phone

(970) 482-9001

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1679509152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 CENTRE AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805261849",
            "telephone_number": "970-482-9001",
            "fax_number": "970-482-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 CENTRE AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805261849",
            "telephone_number": "970-482-9001",
            "fax_number": "970-482-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & LASER CENTER OF FORT COLLINS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "KORNFELD",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "970-482-9001"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "27691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kellie Dequasie, RN
• Jennifer E. Deraad, APRN
• Sandra Marie Deraney Reilly, PHD
• Michael A. Deringer, M.D.
• Peggy Ann Derloshon, DDS
• Dermatology of Northern Colorado P.C.
• Claire Derr
• James Alan Derrisaw, M.D.
• Julie Ann Derry
• Carly Derstine

• Dermatology Physician in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.