Desert Dermatology and Surgery LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

DESERT DERMATOLOGY AND SURGERY LLC

Practice address

272 E Center St Ste 102
Ivins, UT 84738-6456

Phone

(307) 413-3752

NPI assigned

Oct 14, 2024

Last updated

Oct 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christian B Anderson, DONPI 1861538860

Title

Physician Owner

Phone

(307) 413-3752

Specialties & licenses 1

Addresses

Other names 1

• Desert Dermatology and Surgery LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Christian B Anderson, D.O.

  • MOHS-Micrographic Surgery Physician
  • Ivins, UT
  • NPI 1861538860
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1902626047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "756 W SHINAVA DR",
            "city": "IVINS",
            "state": "UT",
            "postal_code": "847386713",
            "telephone_number": "307-413-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 E CENTER ST STE 102",
            "city": "IVINS",
            "state": "UT",
            "postal_code": "847386456",
            "telephone_number": "307-413-3752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT DERMATOLOGY AND SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-14",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "307-413-3752",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Dermatology and Surgery LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Janene Ann Borandi, DAC, LAC
• Paul Brennan
• Rosanne Torres Calure, CRNP
• Bradley Glen Crump, DC
• Sarah Dale
• Mark James Dewey, NP-C
• Jimmy DO
• Emily Eischen Martin
• Excelserv PLLC
• Vaibhav Farkiwala

• MOHS-Micrographic Surgery Physician in Ivins, UT
• Providers in Ivins, UT by specialty
• MOHS-Micrographic Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.