NPI 1073954913

Jordan Valley Dermatology

Organisation Specialist Casper, WY

Practice location

Address: 428 S Durbin St STE 103, Casper, WY 82601-2829
Phone: (307) 234-0003
Fax: (307) 265-6575

Authorised official

Name: Virginia Louise Tubbs
Title: Owner
Phone: (307) 265-2936

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 8624096-4405 (UT)

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Registry record

NPI: 1073954913
Entity type: Organization
NPI issued: 8 Jul 2013
Record last updated: 21 Jun 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.