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General NPI Number Information
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NPI Number | 1093416893
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Entity Type | Organization
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Legal Business Name | ARIZONA INSTITUTE OF DERMATOLOGY PAYSON LLC
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 127 E MAIN ST STE A
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City | PAYSON
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State | AZ
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Zip | 85541-5646
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Country | US
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Telephone | 928-951-0395
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Fax | 928-492-9319
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Provider Business Mailing Address
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Address Line | PO BOX 268920
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER U REX
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Credential |
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Telephone | 928-951-0395
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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 |
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License Number State |
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