Healthcare Provider Details

I. General information

NPI: 1144618943
Provider Name (Legal Business Name): DERMATOLOGY & SKIN SURGERY SPECIALISTS OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 N PIMA RD SUITE 212
SCOTTSDALE AZ
85258-4480
US

IV. Provider business mailing address

8415 N PIMA RD SUITE 212
SCOTTSDALE AZ
85258-4480
US

V. Phone/Fax

Practice location:
  • Phone: 480-434-6600
  • Fax: 480-522-3528
Mailing address:
  • Phone: 480-434-6600
  • Fax: 480-522-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number49128
License Number StateAZ

VIII. Authorized Official

Name: ANNE JAMES GOLDSBERRY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 949-233-5571