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General NPI Number Information
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NPI Number | 1871851691
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Entity Type | Organization
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Legal Business Name | DESERT SKY DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 1688 E. BOSTON ST. SUITE #101
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City | GILBERT
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State | AZ
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Zip | 85295-6220
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Country | US
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Telephone | 480-855-0085
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Fax | 480-855-0086
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Provider Business Mailing Address
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Address Line | 1688 E. BOSTON ST. SUITE #101
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City | GILBERT
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State | AZ
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Zip | 85295-6220
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Country | US
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Telephone | 480-855-0085
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Fax | 480-855-0086
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | CANDICE BERGER
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Credential |
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Telephone | 480-855-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 45370
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 29461
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 45370
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License Number State | AZ
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