MEDICARE: DYSON DERMATOLOGY PLLC

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

General Provider Information

NPI Number	:	1396500476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYSON DERMATOLOGY PLLC

Provider Business Mailing Address
First Line	:	2222 N CRAYCROFT RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2830
Country	:	US
Telephone Number	:	520-838-0777
Fax Number	:	520-838-0669

Provider Business Practice Location Address
First Line	:	516 E WHITEHOUSE CANYON RD STE 100
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-0542
Country	:	US
Telephone Number	:	520-625-0800
Fax Number	:	520-625-1680

Authorized Official
Title or Position	:	PRACTICE ADMIN
Name	:	AMANDA WHITE
Credential	:
Telephone Number	:	520-838-0777

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	02/16/2024

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