DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC (NPI# 1104452804) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104452804 |
| Entity Type | Organization |
| Organization Name | DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC |
| Practice Address |
1327 Eagle Dr Loveland CO 80537-8059 |
| Practice Telephone | 9702862668 |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-03-14 |
| Authorized Official Name | JENNIFER MICHELLE DIVINE (OWNER) |
| Authorized Official Telephone | 9702862668 |
| Is Organization Subpart | Y |
| Parent Organization Name | DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Divine Dermatology and Surgical Institute | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215460290 | Divine Dermatology and Surgical Institute, Pllc | Clinic/Center | 1260 Doctors Ln, Fort Collins, CO 80524-4038 | 2017-04-06 |
| Street Address |
1327 EAGLE DR |
| City | LOVELAND |
| State | CO |
| Zip Code | 80537-8059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447258124 | John Peyton Taliaferro | Family Medicine | 1327 Eagle Dr, Loveland, CO 80537-8059 | 2005-07-07 |
| 1487883203 | Sandra Plybon | Family Medicine | 1327 Eagle Dr, Loveland, CO 80537-8059 | 2009-07-14 |
| 1992895577 | Susan D. Agrama | Internal Medicine | 1327 Eagle Dr, Loveland, CO 80537-8059 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972161073 | Schaeffer Therapy, LLC | Marriage & Family Therapist | 585 North Lincoln Avenue, 571, Loveland, CO 80537 | 2019-06-04 |
| 1447729132 | Mountainside Counseling, Pllc | Clinic/Center | 1380 Denve Ave., Loveland, CO 80537 | 2018-11-26 |
| 1629582945 | Katheryn D Sierocki | Spec/Tech, Health Info | 3918 Joni Ln, Loveland, CO 80537 | 2017-11-22 |
| 1902339963 | Hti2, LLC Dba Pearle Vision Loveland | Point of Service | 1391 Sculptor Dr., Loveland, CO 80537 | 2017-04-06 |
| 1407391980 | Whitney Grigsby | Behavior Technician | 5323 Cedar Valley Drive, Loveland, CO 80537 | 2016-12-20 |
| 1770026940 | Mh Health Care Services, PC | Nurse Practitioner | 1632 Topaz Lane, C/o of City of Loveland Health Center, Loveland, CO 80537 | 2016-11-21 |
| 1417324443 | Erica Hawks | Speech-Language Pathologist | 241 Lori Dr, Loveland, CO 80537 | 2015-08-25 |
| 1356749485 | Traci-ann Seana Reynolds | Dental Hygienist | 1135 N. Lincoln Ave, Suite 4, Loveland, CO 80537 | 2014-12-05 |
| 1215342274 | Charles Lee Simmons Jr. | Counselor | 1905 W 8th St Ste 202, Loveland, CO 80537 | 2014-06-27 |
| 1376979716 | Ariel Friese | Counselor | 832 W Eisenhower Blvd Ste B1, Loveland, CO 80537 | 2013-09-17 |
| Find all providers in zip 80537 | ||||
| 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 |
|---|---|---|---|---|
| 1003011404 | Holly Hare Mccoppin | Dermatology | 1615 Foxtrail Dr Ste 100, Loveland, CO 80538-9087 | 2007-06-18 |
| 1164479416 | David P Clark | Dermatology | 776 W Eisenhower Blvd, Loveland, CO 80537-3157 | 2006-05-30 |
| 1982044012 | Ammon Larsen | Dermatology | 1615 Foxtrail Dr Ste 100, Loveland, CO 80538-9087 | 2013-07-03 |
| 1295776201 | Kevin John Mott | Dermatology | 1708 Boise Ave, Loveland, CO 80538-4204 | 2006-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720685894 | Colorado Springs Dermatology Clinic, P.C. | Dermatology | 1332 Bauer Ln, Canon City, CO 81212-4669 | 2020-10-02 |
| 1891392973 | Colorado Springs Dermatology Clinic, P.C. | Dermatology | 2060 Briargate Pkwy Ste 150, Colorado Springs, CO 80920-7660 | 2020-10-02 |
| 1033723465 | Inspired Dermatology, Pllc | Dermatology | 6050 Greenwood Plaza Blvd Ste 130, Greenwood Village, CO 80111-4823 | 2020-09-02 |
| 1700496668 | Sorkin Dermatology Associates Professional LLC | Dermatology | 1960 N. Ogden Street, Suite 555, Denver, CO 80218-3602 | 2020-08-05 |
| 1194340802 | Epiphany Dermatology of Colorado, LLC | Dermatology | 2530 N 8th St Ste 205, Grand Junction, CO 81501-8858 | 2020-06-09 |
| 1861026189 | University Physicians Incorporated | Dermatology | 14305 E Alameda Ave Ste 225, Aurora, CO 80012-2549 | 2020-02-25 |
| 1316577323 | Medical Man Cave Pllc | Dermatology | 250 Steele Street, Suite 350, Denver, CO 80206-5242 | 2020-01-17 |
| 1124664248 | Allison Marquis | Dermatology | 4350 Limelight Ave Ste 205, Castle Rock, CO 80109-8034 | 2019-11-24 |
| 1790255313 | Core Dermatology, Pllc | Dermatology | 425 South Cherry Suite 907, Glendale, CO 80246 | 2018-11-26 |
| 1326521576 | Kaitlyn Laurel Pell | Dermatology | 125 Inverness Dr E Ste 340, Englewood, CO 80112-5139 | 2018-09-13 |
| Find all providers with the same taxonomy | ||||
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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.