Provider Demographics
NPI:1902626047
Name:DESERT DERMATOLOGY AND SURGERY LLC
Entity type:Organization
Organization Name:DESERT DERMATOLOGY AND SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:307-413-3752
Mailing Address - Street 1:756 W SHINAVA DR
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6713
Mailing Address - Country:US
Mailing Address - Phone:307-413-3752
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST STE 102
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6456
Practice Address - Country:US
Practice Address - Phone:307-413-3752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery