MEDICARE: SOUTHWEST SKIN SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	98010735	AZ

General Provider Information

NPI Number	:	1174521926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST SKIN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	10200 N 92ND ST
Second Line	:	#205
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4534
Country	:	US
Telephone Number	:	602-494-1817
Fax Number	:	602-494-7103

Provider Business Practice Location Address
First Line	:	11130 N TATUM BLVD
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1630
Country	:	US
Telephone Number	:	602-494-1817
Fax Number	:	602-494-7103

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HOWARD JAY LUBER
Credential	:	M. D.
Telephone Number	:	602-494-1817

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/06/2017

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Directions to “SOUTHWEST SKIN SPECIALISTS LLC ” Practice Location

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