Healthcare Provider Details

I. General information

NPI: 1649838756
Provider Name (Legal Business Name): INTEGRATED DERMATOLOGY OF ARIZONA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 E AGAVE RD STE 148
PHOENIX AZ
85044-0623
US

IV. Provider business mailing address

4425 E AGAVE RD STE 148
PHOENIX AZ
85044-0623
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-7546
  • Fax:
Mailing address:
  • Phone: 480-704-7546
  • Fax: 480-704-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH E NEUMANN
Title or Position: AUTHORIZED GROUP OFFICIAL
Credential: PA
Phone: 480-704-7546