Provider Demographics
NPI:1558363465
Name:IRONWOOD DERMATOLOGY, PC
Entity Type:Organization
Organization Name:IRONWOOD DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-618-1630
Mailing Address - Street 1:1735 E SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1162
Mailing Address - Country:US
Mailing Address - Phone:520-618-1630
Mailing Address - Fax:
Practice Address - Street 1:1735 E SKYLINE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1162
Practice Address - Country:US
Practice Address - Phone:520-618-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty