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General NPI Number Information
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NPI Number | 1093081879
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN DERMATOLOGY CARE, PLLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 11000 N SCOTTSDALE RD STE 120
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6169
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Country | US
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Telephone | 480-596-1110
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Fax | 480-596-9969
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Provider Business Mailing Address
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Address Line | 11000 N SCOTTSDALE RD STE 120
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6169
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Country | US
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Telephone | 480-596-1110
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Fax | 480-596-9969
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. BROOKE L BLUMETTI
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Credential | DO
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Telephone | 480-596-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 12450
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License Number State | AZ
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