Kallgren Dermatology Clinic, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

33197 Issued in CO

Legal business name

KALLGREN DERMATOLOGY CLINIC, P.C.

Practice address

3434 47TH St
#200
Boulder, CO 80301-1880

Phone

(303) 444-8100

Fax

(303) 444-8113

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Maguire

Title

Office Manager

Phone

(303) 444-8100

Specialties & licenses 2

Addresses

Practitioners 1

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

• Catherine Wherry Pacocha, MPAS PA-C

  • Physician Assistant
  • Steamboat Springs, CO
  • NPI 1205817483
  NPD (past)

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1790978393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 47TH ST",
            "address_2": "#200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011880",
            "telephone_number": "303-444-8100",
            "fax_number": "303-444-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 47TH ST",
            "address_2": "#200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011880",
            "telephone_number": "303-444-8100",
            "fax_number": "303-444-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALLGREN DERMATOLOGY CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "MAGUIRE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "303-444-8100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "33197",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CO",
            "license": "33197",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ai Kakuta
• Jeremy Kalan, LPCC, CPCC
• Kelly Kale, RBT
• Lisa Kalfas, DDS
• Kallgren Dermatology
• Diane Lucy Kallgren, M.D.
• Nataraja Kallio, MA, LPCC
• Vinaya K Kamath, M.D.
• Robert James Kammer Jr., DDS
• Jill Kamon, M.D.

• Dermatology Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.