Provider Demographics
NPI:1407058324
Name:DERMATOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-866-3344
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:SUITE C-600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-866-3344
Mailing Address - Fax:602-375-2088
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:SUITE C-600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-866-3344
Practice Address - Fax:602-375-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13703207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0051960OtherBCBS
AZ1700868833OtherINDIVIDUAL NPI #
AZ121777OtherHEALTHNET #
AZ1700868833OtherINDIVIDUAL NPI #
AZE3930Medicare UPIN