Healthcare Provider Details

I. General information

NPI: 1992061162
Provider Name (Legal Business Name): ARIZONA DERMATOLOGY SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 W. MOUNTAIN VIEW BLVD. STE. 160
SURPRISE AZ
85374-2700
US

IV. Provider business mailing address

P.O. BOX 9290
SURPRISE AZ
85374-9290
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-3376
  • Fax: 623-584-3375
Mailing address:
  • Phone: 623-584-3376
  • Fax: 623-584-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number29708
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number29708
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JAMES O BARLOW
Title or Position: OWNER/MEMBER
Credential: M.D.
Phone: 602-793-8411