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General NPI Number Information
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NPI Number | 1437914819
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Entity Type | Organization
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Legal Business Name | RED MOUNTAIN DERMATOLOGY LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 1611 E WARNER RD STE 5
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City | TEMPE
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State | AZ
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Zip | 85284-4550
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Country | US
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Telephone | 480-454-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 2753 E BROADWAY RD # 101-436
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City | MESA
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State | AZ
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Zip | 85204-1579
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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 | RYAN KIRK BINGHAM
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Credential |
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Telephone | 480-625-4538
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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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