MEDICARE: ALL DERMATOLOGY, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207K00000X	Allergy & Immunology Physician
2	207KA0200X	Allergy Physician
3	207N00000X	Dermatology Physician
4	207ND0101X	MOHS-Micrographic Surgery Physician
5	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician
6	207NP0225X	Pediatric Dermatology Physician
7	207NS0135X	Procedural Dermatology Physician
8	207ND0900X	Dermatopathology Physician

General Provider Information

NPI Number	:	1558525824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL DERMATOLOGY, INC.

Provider Business Mailing Address
First Line	:	14239 W BELL RD
Second Line	:	SUITE 101
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2469
Country	:	US
Telephone Number	:	623-544-7755
Fax Number	:	623-544-8665

Provider Business Practice Location Address
First Line	:	4400 N 32ND ST
Second Line	:	SUITE 250
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3953
Country	:	US
Telephone Number	:	602-277-7686
Fax Number	:	602-277-0407

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MR. JAMES F PEHOUSHEK
Credential	:	M.D.
Telephone Number	:	623-544-7755

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	06/27/2019

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Directions to “ALL DERMATOLOGY, INC. ” Practice Location

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