Healthcare Provider Details

I. General information

NPI: 1588610422
Provider Name (Legal Business Name): NEIL P. SUPERFON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 E 2ND ST STE 310
SCOTTSDALE AZ
85251-5627
US

IV. Provider business mailing address

7301 E 2ND ST STE 310
SCOTTSDALE AZ
85251-5627
US

V. Phone/Fax

Practice location:
  • Phone: 602-754-6075
  • Fax: 623-230-6814
Mailing address:
  • Phone: 602-754-6075
  • Fax: 623-230-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number754
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number754
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number754
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number754
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: