Provider Demographics
NPI:1184681132
Name:SKIN AND CANCER CENTER OF ARIZONA PC
Entity Type:Organization
Organization Name:SKIN AND CANCER CENTER OF ARIZONA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MD MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BURRELL
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:WOLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-899-7546
Mailing Address - Street 1:725 S DOBSON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-899-7546
Mailing Address - Fax:480-899-7599
Practice Address - Street 1:725 S DOBSON RD
Practice Address - Street 2:STE 200
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-899-7546
Practice Address - Fax:480-899-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10131207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZWCLJD01Medicare ID - Type Unspecified
D37868Medicare UPIN