Healthcare Provider Details

I. General information

NPI: 1174635031
Provider Name (Legal Business Name): SCOTTSDALE DERMATOLOGY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 N MILLER RD STE D
SCOTTSDALE AZ
85251-6489
US

IV. Provider business mailing address

3302 N MILLER RD STE D
SCOTTSDALE AZ
85251-6489
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-6356
  • Fax: 480-946-9565
Mailing address:
  • Phone: 480-945-6356
  • Fax: 480-946-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15963
License Number StateAZ

VIII. Authorized Official

Name: GLENN K YARBROUGH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-945-6356