Provider Demographics
NPI:1174635031
Name:SCOTTSDALE DERMATOLOGY, LTD
Entity Type:Organization
Organization Name:SCOTTSDALE DERMATOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:K
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-945-6356
Mailing Address - Street 1:3302 N MILLER RD STE D
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6489
Mailing Address - Country:US
Mailing Address - Phone:480-945-6356
Mailing Address - Fax:480-946-9565
Practice Address - Street 1:3302 N MILLER RD STE D
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6489
Practice Address - Country:US
Practice Address - Phone:480-945-6356
Practice Address - Fax:480-946-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty