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ISLAND COUNTY DERMATOLOGY, PLLC

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Company Details

Legal Name: ISLAND COUNTY DERMATOLOGY, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Inactive
Formation/ Registration Date: November 9th 1999
Date of Dissolution: March 1st 2012
Expiration date: 30 Nov 2011
UBI Number: 601 992 068
ZIP code: 98221
City: Anacortes
County: SKAGIT
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 3110 COMMERCIAL ST #105, ANACORTES, WA, 98221, UNITED STATES

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Registered Agent Information

Name Role Address
DONALD RUSSELL JOHNSON MD PHD Registered Agent 3110 COMMERCIAL ST #105, ANACORTES, WA, 98221, UNITED STATES

Key Officers & Management

Name Role Address
MARIANNE BAKER Governing Person 3110 COMMERCIAL AVENUE SUITE #, ANACORTES, WA, 98221, UNITED STATES
DONALD JOHNSON MD Governing Person 3110 COMMERCIAL AVENUE SUITE #, ANACORTES, WA, 98221, UNITED STATES

National Provider Identifier

NPI Number:
1144496613

Authorized Person:

Name:
DR. DONALD RUSSELL JOHNSON
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

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