Provider Demographics
NPI:1447713573
Name:DERMATOLOGY HEALTH SPECIALISTS, PC
Entity type:Organization
Organization Name:DERMATOLOGY HEALTH SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:WISCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-632-5544
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0831
Mailing Address - Country:US
Mailing Address - Phone:210-632-5544
Mailing Address - Fax:
Practice Address - Street 1:1693 SW CHANDLER AVE STE 250
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3231
Practice Address - Country:US
Practice Address - Phone:210-632-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty