Provider Demographics
NPI:1225416456
Name:PHYSICIAN SKIN SOLUTIONS
Entity Type:Organization
Organization Name:PHYSICIAN SKIN SOLUTIONS
Other - Org Name:PHYSICIAN SKIN AT ARROWHEAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:MALTAIS
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:602-843-4040
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:SUITE C-116
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-843-4040
Mailing Address - Fax:602-843-4077
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:SUITE C-116
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-843-4040
Practice Address - Fax:602-843-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-805207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty