Provider Demographics
NPI:1588610422
Name:SUPERFON, NEIL P (DO)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:P
Last Name:SUPERFON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 E 2ND ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5627
Mailing Address - Country:US
Mailing Address - Phone:602-754-6075
Mailing Address - Fax:623-230-6814
Practice Address - Street 1:7301 E 2ND ST STE 310
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5627
Practice Address - Country:US
Practice Address - Phone:602-754-6075
Practice Address - Fax:623-230-6814
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ754207ND0900X, 207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4022597OtherAETNA
AZAZ0063290OtherBLUE CROSS
AZ227860Medicaid
AZ2Z2527OtherHEALTHNET
AZAZ0063290OtherBLUE CROSS
AZ2Z2527OtherHEALTHNET
AZWCKHZ01Medicare ID - Type UnspecifiedPHX LOCATION