Healthcare Provider Details

I. General information

NPI: 1265518161
Provider Name (Legal Business Name): MOUNTAINVIEW DERMATOLOGY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 N WYATT DR SUITE 109
TUCSON AZ
85712-2152
US

IV. Provider business mailing address

2375 N WYATT DR SUITE 109
TUCSON AZ
85712-2152
US

V. Phone/Fax

Practice location:
  • Phone: 520-881-8161
  • Fax: 520-881-8163
Mailing address:
  • Phone: 520-881-8161
  • Fax: 520-881-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2881
License Number StateAZ

VIII. Authorized Official

Name: DR. MARC IRWIN EPSTEIN
Title or Position: PRESIDENT/DERMATOLOGIST
Credential: D.O.
Phone: 520-881-8161