Provider Demographics
NPI:1386062156
Name:FROMM DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:FROMM DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:FROMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-721-5550
Mailing Address - Street 1:4447 S CANYON RD STE 6
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-1889
Mailing Address - Country:US
Mailing Address - Phone:605-721-5550
Mailing Address - Fax:605-721-5515
Practice Address - Street 1:4447 S CANYON RD STE 6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1889
Practice Address - Country:US
Practice Address - Phone:605-721-5550
Practice Address - Fax:605-721-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8292261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty