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General NPI Number Information
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NPI Number | 1801327309
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Entity Type | Individual
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Provider Name | JONATHAN LAVIAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 04/20/2025
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Provider Practice Location Address
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Address Line | 2127 E BASELINE RD STE 104
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City | TEMPE
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State | AZ
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Zip | 85283-1537
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Country | US
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Telephone | 804-556-0446
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Fax | 480-556-0447
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Provider Business Mailing Address
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Address Line | 13835 N TATUM BLVD STE 9-268
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City | PHOENIX
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State | AZ
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Zip | 85032-5590
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Country | US
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Telephone | 480-418-3314
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Fax | 480-923-6586
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 66845
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 66845
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License Number State | AZ
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