MEDICARE: MR. NEIL P. SUPERFON D.O.

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	207ND0900X	Dermatopathology Physician	754	AZ
2	207ND0101X	MOHS-Micrographic Surgery Physician	754	AZ
3	207NS0135X	Procedural Dermatology Physician	754	AZ
4	207N00000X	Dermatology Physician	754	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4022597	OTHER	AZ	AETNA
2	AZ0063290	OTHER	AZ	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2Z2527	OTHER	AZ	HEALTHNET

General Provider Information

NPI Number	:	1588610422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEIL P. SUPERFON D.O.

Provider Business Mailing Address
First Line	:	7301 E 2ND ST STE 310
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-5627
Country	:	US
Telephone Number	:	602-754-6075
Fax Number	:	623-230-6814

Provider Business Practice Location Address
First Line	:	7301 E 2ND ST STE 310
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-5627
Country	:	US
Telephone Number	:	602-754-6075
Fax Number	:	623-230-6814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/28/2024

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Directions to “ MR. NEIL P. SUPERFON D.O.” Practice Location

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