Provider Demographics
NPI:1487842043
Name:ASSOCIATED DERMATOLOGISTS, P.C.
Entity Type:Organization
Organization Name:ASSOCIATED DERMATOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:520-290-8555
Mailing Address - Street 1:6296 E GRANT RD
Mailing Address - Street 2:STE. 180
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5833
Mailing Address - Country:US
Mailing Address - Phone:520-290-8555
Mailing Address - Fax:520-290-6470
Practice Address - Street 1:6296 E GRANT RD
Practice Address - Street 2:STE. 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5833
Practice Address - Country:US
Practice Address - Phone:520-290-8555
Practice Address - Fax:520-290-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCKCPOtherMEDICARE GROUP ID
AZZWCKCQMedicare PIN
AZZWDBYQMedicare PIN