Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Dermatology LLC

Organization Dermatology Physician · NPI 1568029957

Providence Dermatology LLC is a Dermatology Physician in Providence, Utah. Works from 2 locations. Registered with an NPI since 2019.

In the registry since
2019
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

169 N Gateway Dr Ste 100
Providence, UT 84332-9860
Phone: (541) 999-4475
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 950 Medical Dr Ste 311, Brigham City, UT 84302-4724 — (435) 554-1182

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X
MOHS-Micrographic Surgery Physician Taxonomy 207ND0101X

Record details

NPI number1568029957
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Travis James — Owner/Physician · (435) 554-1182
Other names Providence Dermatology
NPI enumeratedMay 22, 2019
Last updated in NPPESJune 16, 2025
Certification dateJune 16, 2025
Mailing address169 N Gateway Dr Ste 100, Providence, UT 84332-9860

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