Provider Demographics
NPI:1063300580
Name:MAT-SU DERMATOLOGY, LLC
Entity type:Organization
Organization Name:MAT-SU DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:OUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-707-6381
Mailing Address - Street 1:1398 N RIVER ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9732
Mailing Address - Country:US
Mailing Address - Phone:907-745-7546
Mailing Address - Fax:
Practice Address - Street 1:2250 S WOODWORTH LOOP # C
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7457
Practice Address - Country:US
Practice Address - Phone:907-745-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty