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General NPI Number Information
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NPI Number | 1952573636
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Entity Type | Organization
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Legal Business Name | SAGUARO DERMATOLOGY PC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 5577 N ORACLE RD SUITE 103
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City | TUCSON
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State | AZ
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Zip | 85704-3821
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Country | US
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Telephone | 520-293-9100
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Fax | 520-293-8654
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Provider Business Mailing Address
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Address Line | 5577 N ORACLE RD SUITE 103
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City | TUCSON
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State | AZ
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Zip | 85704-3821
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Country | US
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Telephone | 520-293-9100
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Fax | 520-293-8654
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN M HARALDSEN
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Credential | MD
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Telephone | 520-293-9100
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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 | 9467
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License Number State | AZ
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