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General NPI Number Information
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NPI Number | 1568833994
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE DERMATOLOGY, LTD
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 20940 N TATUM BLVD SUITE 270
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City | PHOENIX
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State | AZ
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Zip | 85050-4265
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Country | US
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Telephone | 480-502-0400
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Fax | 480-502-0432
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Provider Business Mailing Address
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Address Line | 20940 N TATUM BLVD SUITE 270
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City | PHOENIX
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State | AZ
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Zip | 85050-4265
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Country | US
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Telephone | 480-502-0400
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Fax | 480-502-0432
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. GLENN KEVIN YARBROUGH
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Credential | MD
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Telephone | 480-945-6356
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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 | AZ15963
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License Number State | AZ
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