Provider Demographics
NPI:1144618943
Name:DERMATOLOGY & SKIN SURGERY SPECIALISTS OF ARIZONA, LLC
Entity Type:Organization
Organization Name:DERMATOLOGY & SKIN SURGERY SPECIALISTS OF ARIZONA, LLC
Other - Org Name:DERMATOLOGY & SKIN SURGERY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GOLDSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-233-5571
Mailing Address - Street 1:8415 N PIMA RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4480
Mailing Address - Country:US
Mailing Address - Phone:480-434-6600
Mailing Address - Fax:480-522-3528
Practice Address - Street 1:8415 N PIMA RD
Practice Address - Street 2:SUITE 212
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4480
Practice Address - Country:US
Practice Address - Phone:480-434-6600
Practice Address - Fax:480-522-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49128207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty