Provider Demographics
NPI:1992992150
Name:C.W. DERM, LLC
Entity type:Organization
Organization Name:C.W. DERM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:STIEFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-245-1500
Mailing Address - Street 1:2530 N 8TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8858
Mailing Address - Country:US
Mailing Address - Phone:970-245-1500
Mailing Address - Fax:970-245-1513
Practice Address - Street 1:2530 N 8TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8858
Practice Address - Country:US
Practice Address - Phone:970-245-1500
Practice Address - Fax:970-245-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19716207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC439868Medicare PIN