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General NPI Number Information
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NPI Number | 1174521926
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Entity Type | Organization
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Legal Business Name | SOUTHWEST SKIN SPECIALISTS LLC
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 11130 N TATUM BLVD SUITE 100
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City | PHOENIX
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State | AZ
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Zip | 85028-1630
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Country | US
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Telephone | 602-494-1817
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Fax | 602-494-7103
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Provider Business Mailing Address
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Address Line | 10200 N 92ND ST #205
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4534
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Country | US
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Telephone | 602-494-1817
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Fax | 602-494-7103
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOWARD JAY LUBER
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Credential | M. D.
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Telephone | 602-494-1817
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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 | 98010735
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License Number State | AZ
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