Pilot Butte Dermatology, L.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

8010A Issued in WY

Legal business name

PILOT BUTTE DERMATOLOGY, L.C.

Practice address

196 Arrowhead Dr
Suite 5
Evanston, WY 82930-8752

Phone

(877) 689-0005

Fax

(801) 565-7931

NPI assigned

Feb 25, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Douglass W. Forsha, M.D.

Title

President

Phone

(801) 569-1456

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Valley Dermatology Other name

Locations

Practitioners 1

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

• Virginia Louise Tubbs, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Casper, WY
  • NPI 1609034131
  NPD (past)

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

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1871733238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3570 W 9000 S",
            "address_2": "#220",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840888869",
            "telephone_number": "801-569-1456",
            "fax_number": "801-565-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 ARROWHEAD DR",
            "address_2": "SUITE 5",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829308752",
            "telephone_number": "877-689-0005",
            "fax_number": "801-565-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PILOT BUTTE DERMATOLOGY, L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "FORSHA",
        "authorized_official_first_name": "DOUGLASS",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-569-1456",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WY",
            "license": "8010A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506808177021",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Valley Dermatology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Parvanae Pentico
• Sydney M. Perate, M.S
• Carmen Kay Peters-Wood
• Suzanne Petren
• Tiffany Lynn Pieger, CMT
• Peter Thomas Pinto, MD
• Pioneer Counseling Services
• Pioneer Counseling Services
• Pioneer Counseling Services
• Pioneer Counseling Services

• Specialist in Evanston, WY
• Providers in Evanston, WY by specialty
• Specialist in Wyoming

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