Provider Demographics
NPI:1467759274
Name:ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD.
Entity Type:Organization
Organization Name:ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD.
Other - Org Name:ARIZONA DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUPERFON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-277-2247
Mailing Address - Street 1:2224 W NORTHERN AVE
Mailing Address - Street 2:SUITE D-300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4928
Mailing Address - Country:US
Mailing Address - Phone:602-277-1449
Mailing Address - Fax:602-277-9984
Practice Address - Street 1:10440 E RIGGS RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7751
Practice Address - Country:US
Practice Address - Phone:480-818-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA SKIN AND LASER THERAPY INSITUTE, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty