Provider Demographics
NPI:1609078997
Name:PHOENIX SKIN II PC
Entity Type:Organization
Organization Name:PHOENIX SKIN II PC
Other - Org Name:PHOENIX SKIN MEDICAL SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-222-9111
Mailing Address - Street 1:5056 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1521
Mailing Address - Country:US
Mailing Address - Phone:602-222-9111
Mailing Address - Fax:602-277-5111
Practice Address - Street 1:5056 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1521
Practice Address - Country:US
Practice Address - Phone:602-222-9111
Practice Address - Fax:602-277-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty