Healthcare Provider Details

I. General information

NPI: 1932630563
Provider Name (Legal Business Name): REGENCY SKIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14725 W MOUNTAIN VIEW BLVD
SURPRISE AZ
85374-2704
US

IV. Provider business mailing address

10240 W INDIAN SCHOOL RD SUITE 115
PHOENIX AZ
85037-5904
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-9077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number49090
License Number StateAZ

VIII. Authorized Official

Name: JASON LEE MUSSMAN
Title or Position: PLASTIC SURGEON
Credential: M.D.
Phone: 989-255-4794