Healthcare Provider Details

I. General information

NPI: 1578068250
Provider Name (Legal Business Name): CYNTHIA J PRICE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 E CAMELBACK RD STE 220
SCOTTSDALE AZ
85251-2012
US

IV. Provider business mailing address

6710 E CAMELBACK RD STE 220
SCOTTSDALE AZ
85251-2012
US

V. Phone/Fax

Practice location:
  • Phone: 480-946-7939
  • Fax:
Mailing address:
  • Phone: 480-946-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number35933
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35933
License Number StateAZ

VIII. Authorized Official

Name: MRS. CAROL ANNE PALMER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 480-946-7939