Advanced Dermatology of Wyoming, INC

NPI #1427408319 in Jackson, Wyoming

Provider Information

NPI Number: 1427408319
Entity Type: Organization
Organization Name: Advanced Dermatology of Wyoming, INC
Primary Specialty: Dermatology
Enumeration Date: Jun 21, 2016
Last Updated: Oct 6, 2016

Practice Location

Address: 62 SOUTH REDMOND STREET
City: Jackson
State: Wyoming
ZIP Code: 83001-8664
Phone: (307) 734-5864

Authorized Official

Name: LINDA CRANDALL
Title: CREDENTIALING COORDINATOR
Phone: (970) 484-3050

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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