Provider Demographics
NPI:1649838756
Name:INTEGRATED DERMATOLOGY OF ARIZONA, PLLC
Entity type:Organization
Organization Name:INTEGRATED DERMATOLOGY OF ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED GROUP OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:480-704-7546
Mailing Address - Street 1:4425 E AGAVE RD STE 148
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-0623
Mailing Address - Country:US
Mailing Address - Phone:480-704-7546
Mailing Address - Fax:480-704-7549
Practice Address - Street 1:4425 E AGAVE RD STE 148
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0623
Practice Address - Country:US
Practice Address - Phone:480-704-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty