Provider Demographics
NPI:1922564707
Name:MACHUZAK DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:MACHUZAK DERMATOLOGY PLLC
Other - Org Name:JM DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-621-2070
Mailing Address - Street 1:3198 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2239
Mailing Address - Country:US
Mailing Address - Phone:928-202-4143
Mailing Address - Fax:928-233-8917
Practice Address - Street 1:3198 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2239
Practice Address - Country:US
Practice Address - Phone:928-202-4143
Practice Address - Fax:928-233-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-16
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ453107Medicaid