PARK CITY DERMATOLOGY. CO (NPI# 1316095722) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316095722 |
| Entity Type | Organization |
| Organization Name | PARK CITY DERMATOLOGY. CO |
| Other Organization Name | PARK CITY DERMATOLOGY |
| Practice Address |
1790 Sun Peak Dr Ste A103 Park City UT 84098 |
| Mailing Address |
1790 Sun Peak Dr Ste A103 Park City UT 84098-6625 |
| Practice Telephone | 4356581013 |
| Practice Fax Number | 4356583513 |
| Mailing Telephone | 4356581013 |
| Mailing Fax Number | 4356583513 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | DR. STEVEN MARK KERN (PRESIDENT) |
| Authorized Official Telephone | 4356581013 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PARK CITY DERMATOLOGY. CO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 3673151205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | DEA | BK2420987 | 01 |
| Other Name | Type Code |
|---|---|
| CENTER FOR COSMETIC DERMATOLOGY | Former Legal Business Name - Organization |
| Park City Dermatology | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2700 Homestead Rd, Suite 30, Park City, UT 840984857 | 4356581013 | 4356583513 |
| Street Address |
1790 SUN PEAK DR STE A103 |
| City | PARK CITY |
| State | UT |
| Zip Code | 84098 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104814102 | Steven Mark Kern | Dermatology | 1790 Sun Peak Dr Ste A103, Park City, UT 84098 | 2005-10-12 |
| 1134638810 | Jaddon Trent Rogers | Physician Assistant | 1790 Sun Peak Dr Ste A103, Park City, UT 84098-6625 | 2017-09-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972069532 | Natasha Nicolle Peterson | Nurse Practitioner | Stat Md, 1784 Uinta Way E, Park City, UT 84098 | 2019-02-19 |
| 1750732079 | Rebecca Hansen | Physical Therapist | 1640 W Redstone Center Dr, Suite 200, Park City, UT 84098 | 2016-06-28 |
| 1497126130 | Megan Franz | Counselor | 3100 Pinebrook Rd, Park City, UT 84098 | 2015-10-07 |
| 1568752541 | Kortney James Stirland | Pharmacist | 750 Round Valley Drive #203, Park City, UT 84098 | 2011-04-12 |
| 1265763379 | Amy S Koch | Physical Therapy Assistant | 1640 West Redstone Drive, Suite 200, Park City, UT 84098 | 2010-01-29 |
| 1134374648 | Donna B Fischer | General Practice | 6531 N Landmark Dr., Park City, UT 84098 | 2008-11-25 |
| 1962659458 | Patricia A Lindsay Phd Inc | Psychologist | 1743 W Redstone Ctr Dr, #115, Park City, UT 84098 | 2008-08-26 |
| 1437314291 | Jeffrey S Holverson | Internal Medicine | 6240 N Snowview Dr, Park City, UT 84098 | 2008-07-22 |
| 1578728515 | Blair Archbold Smith | Physical Therapist | 6880 Canyon Drive Court, Park City, UT 84098 | 2008-07-18 |
| 1821255274 | Beth Anita Rylands | Physical Therapy Assistant | 1640 W. Redstone Center Dr., Suite 200, Park City, UT 84098 | 2008-05-21 |
| Find all providers in zip 84098 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902977937 | Lake Shore Dermatology, Ltd. | Dermatology | 351 S. Greenleaf, Suite E, Park City, IL 60085 | 2006-11-13 |
| 1104814102 | Steven Mark Kern | Dermatology | 1790 Sun Peak Dr Ste A103, Park City, UT 84098 | 2005-10-12 |
| 1316470750 | The Dermatology House PC | Dermatology | 1526 Ute Blvd, Ste 104, Park City, UT 84098-7522 | 2017-04-04 |
| 1629149653 | Kavitha Gandhi | Dermatology | 351 S. Greenleaf, Suite E, Park City, IL 60085 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245863893 | Central Utah Dermatology | Dermatology | 861 N Main, Richfield, UT 84701 | 2020-02-21 |
| 1548810401 | Smart & Gibbs | Dermatology | 3200 W Clubhouse Dr Ste 100, Lehi, UT 84043-4325 | 2019-09-12 |
| 1043874332 | Waymore Shade LLC | Dermatology | 451 S Main St Ste 1, Springville, UT 84663-2293 | 2019-04-23 |
| 1598261869 | Tuttle Dermatology PC | Dermatology | 617 E Riverside Dr Ste 103, St George, UT 84790-8049 | 2018-04-04 |
| 1770099251 | Ihc Health Services Inc | Dermatology | 395 W Bulldog Blvd Ste 604, Provo, UT 84604-3331 | 2017-12-20 |
| 1417467986 | Red Ledges Dermatology Pllc | Dermatology | 1449 N 1400 W Ste 22, St George, UT 84770-5237 | 2017-10-10 |
| 1649724139 | University of Utah Adult Services | Dermatology | 165 N. University Ave. Farmington, Farmington, UT 84025 | 2016-08-12 |
| 1861861155 | Brent H. Goodsell, Do | Dermatology | 162 S 1100 E, American Fork, UT 84003-2817 | 2015-09-17 |
| 1912316654 | Jeanna Tachiki Ryan | Dermatology | 243 E 6100 S, Murray, UT 84107-7302 | 2014-08-07 |
| 1659785889 | Dana Rice | Dermatology | 6095 S Fashion Blvd Ste 270, Murray, UT 84107-7387 | 2014-06-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.