Provider Demographics
NPI:1396944286
Name:DERMATOLOGY PC
Entity type:Organization
Organization Name:DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-865-2331
Mailing Address - Street 1:404 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2806
Mailing Address - Country:US
Mailing Address - Phone:308-865-2331
Mailing Address - Fax:308-865-2883
Practice Address - Street 1:404 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2806
Practice Address - Country:US
Practice Address - Phone:308-865-2331
Practice Address - Fax:308-865-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-12-17
Deactivation Date:2007-11-05
Deactivation Code:
Reactivation Date:2007-12-17
Provider Licenses
StateLicense IDTaxonomies
NE17666207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty