Provider Demographics
NPI:1952573636
Name:SAGUARO DERMATOLOGY PC
Entity Type:Organization
Organization Name:SAGUARO DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARALDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-293-9100
Mailing Address - Street 1:5577 N ORACLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3821
Mailing Address - Country:US
Mailing Address - Phone:520-293-9100
Mailing Address - Fax:520-293-8654
Practice Address - Street 1:5577 N ORACLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3821
Practice Address - Country:US
Practice Address - Phone:520-293-9100
Practice Address - Fax:520-293-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9467207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z0000BGNBTMedicare PIN
C99614Medicare PIN