Healthcare Provider Details

I. General information

NPI: 1871773325
Provider Name (Legal Business Name): ASSOCIATED DERMATOLOGISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 N LIMESTONE ST
SPRINGFIELD OH
45503-2646
US

IV. Provider business mailing address

1671 N LIMESTONE ST
SPRINGFIELD OH
45503-2646
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-5911
  • Fax:
Mailing address:
  • Phone: 937-399-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35030442
License Number StateOH

VIII. Authorized Official

Name: DR. JOE MICHAEL HAZEL
Title or Position: DOCTOR/PRESIDENT
Credential: M.D.
Phone: 937-399-5911