Provider Demographics
NPI:1003204975
Name:VERNON T MACKEY, PC
Entity Type:Organization
Organization Name:VERNON T MACKEY, PC
Other - Org Name:ADVANCED DESERT DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-977-6700
Mailing Address - Street 1:9191 W THUNDERBIRD RD STE D101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4270
Mailing Address - Country:US
Mailing Address - Phone:623-977-6700
Mailing Address - Fax:623-977-6771
Practice Address - Street 1:9191 W THUNDERBIRD RD STE D101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4270
Practice Address - Country:US
Practice Address - Phone:623-977-6700
Practice Address - Fax:623-977-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3535207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty