Healthcare Provider Details

I. General information

NPI: 1306599063
Provider Name (Legal Business Name): AZ SKIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7137 E RANCHO VISTA DR STE 121
SCOTTSDALE AZ
85251-2017
US

IV. Provider business mailing address

7137 E RANCHO VISTA DR STE 121
SCOTTSDALE AZ
85251-2017
US

V. Phone/Fax

Practice location:
  • Phone: 646-919-1359
  • Fax:
Mailing address:
  • Phone: 646-919-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. D. B. LAYTON
Title or Position: DERMATOLOGIST
Credential: MD
Phone: 646-919-1359