Provider Demographics
NPI:1386836351
Name:DERMATOLOGY CLINIC LTD
Entity Type:Organization
Organization Name:DERMATOLOGY CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-277-4455
Mailing Address - Street 1:1110 E MISSOURI AVE
Mailing Address - Street 2:600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2707
Mailing Address - Country:US
Mailing Address - Phone:602-277-4455
Mailing Address - Fax:602-277-9654
Practice Address - Street 1:1110 E MISSOURI AVE
Practice Address - Street 2:600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2707
Practice Address - Country:US
Practice Address - Phone:602-277-4455
Practice Address - Fax:602-277-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty