Provider Demographics
NPI:1376883801
Name:INTEGRATED DERMATOLOGY OF YUMA PLLC
Entity Type:Organization
Organization Name:INTEGRATED DERMATOLOGY OF YUMA PLLC
Other - Org Name:DERMATOLOGY CENTER OF YUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:PLOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-314-2000
Mailing Address - Street 1:4700 EXCHANGE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4450
Mailing Address - Country:US
Mailing Address - Phone:561-314-2000
Mailing Address - Fax:
Practice Address - Street 1:2500 S 8TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7108
Practice Address - Country:US
Practice Address - Phone:928-783-0169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty