Provider Demographics
NPI:1265518161
Name:MOUNTAINVIEW DERMATOLOGY, LTD
Entity type:Organization
Organization Name:MOUNTAINVIEW DERMATOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-881-8161
Mailing Address - Street 1:2375 N WYATT DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2152
Mailing Address - Country:US
Mailing Address - Phone:520-881-8161
Mailing Address - Fax:520-881-8163
Practice Address - Street 1:2375 N WYATT DR
Practice Address - Street 2:SUITE 109
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2152
Practice Address - Country:US
Practice Address - Phone:520-881-8161
Practice Address - Fax:520-881-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2881207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG05456Medicare UPIN