Provider Demographics
NPI:1013181080
Name:MEDICAL DERMATOLOGY SPECIALISTS, PC
Entity Type:Organization
Organization Name:MEDICAL DERMATOLOGY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:SKYE
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-481-7593
Mailing Address - Street 1:PO BOX 504676
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4676
Mailing Address - Country:US
Mailing Address - Phone:602-354-5770
Mailing Address - Fax:602-354-5607
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-354-5770
Practice Address - Fax:602-354-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ377554207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z122739Medicare PIN