OrganizationActive
Providence Dermatology LLC
NPI 1568029957 · Dermatology Physician · Providence, UT
Provider details
- NPI number
- 1568029957
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Travis James, Owner/Physician(435) 554-1182
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- MOHS-Micrographic Surgery Physician207ND0101X
Allopathic & Osteopathic Physicians
Practice location
169 N Gateway Dr Ste 100
Providence, UT 84332-9860
Phone: (541) 999-4475
Approximate (ZIP-level) locationGet directions
Mailing address
169 N Gateway Dr Ste 100
Providence, UT 84332-9860
Other names (DBA / former)
- Doing business as
- Providence Dermatology
Additional practice locations (1)
- 950 Medical Dr Ste 311Brigham City, UT 84302-4724Phone: (435) 554-1182Fax: (435) 554-1950
Registry dates
- Enumerated
- 2019-05-22
- Last updated
- 2025-06-16
- Certified
- 2025-06-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.