Provider Demographics
NPI:1740373257
Name:ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD
Entity type:Organization
Organization Name:ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUPERFON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-277-1449
Mailing Address - Street 1:2224 W NORTHERN AVE STE D300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5099
Mailing Address - Country:US
Mailing Address - Phone:602-277-1449
Mailing Address - Fax:602-277-9984
Practice Address - Street 1:1500 S WHITE MOUNTAIN RD STE 201
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7116
Practice Address - Country:US
Practice Address - Phone:928-537-2550
Practice Address - Fax:928-537-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty