Healthcare Provider Details

I. General information

NPI: 1902865959
Provider Name (Legal Business Name): RICHARD L AVERITTE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20401 N 73RD ST STE 230
SCOTTSDALE AZ
85255-4107
US

IV. Provider business mailing address

20401 N 73RD ST STE 230
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 480-556-0446
  • Fax: 480-223-6900
Mailing address:
  • Phone: 480-556-0446
  • Fax: 480-223-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number30247
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number30247
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number30247
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: