Provider Demographics
NPI:1417041963
Name:PLAZA DERMATOLOGY, SC
Entity type:Organization
Organization Name:PLAZA DERMATOLOGY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NYLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ESKRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-344-4573
Mailing Address - Street 1:3508 E MARIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1334
Mailing Address - Country:US
Mailing Address - Phone:715-344-4573
Mailing Address - Fax:715-344-4356
Practice Address - Street 1:3508 E MARIA DRIVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1334
Practice Address - Country:US
Practice Address - Phone:715-344-4573
Practice Address - Fax:715-344-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16752174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty