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General NPI Number Information
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NPI Number | 1003934977
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Entity Type | Organization
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Legal Business Name | OLD PUEBLO DERMATOLOGY LTD
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1980 W HOSPITAL DR #307
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City | TUCSON
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State | AZ
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Zip | 85704-7802
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Country | US
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Telephone | 520-742-7777
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Fax | 520-742-9316
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Provider Business Mailing Address
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Address Line | 1980 W HOSPITAL DR #307
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City | TUCSON
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State | AZ
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Zip | 85704-7802
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Country | US
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Telephone | 520-742-7777
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Fax | 520-742-9316
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH DAVID SOSNOW
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Credential | MD
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Telephone | 520-742-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9882
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License Number State | AZ
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