MEDICARE: MOUNTAINVIEW DERMATOLOGY, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0900X	Dermatopathology Physician	2881	AZ

General Provider Information

NPI Number	:	1265518161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINVIEW DERMATOLOGY, LTD

Provider Business Mailing Address
First Line	:	2375 N WYATT DR
Second Line	:	SUITE 109
City	:	TUCSON
State	:	AZ
Zip	:	85712-2152
Country	:	US
Telephone Number	:	520-881-8161
Fax Number	:	520-881-8163

Provider Business Practice Location Address
First Line	:	2375 N WYATT DR
Second Line	:	SUITE 109
City	:	TUCSON
State	:	AZ
Zip	:	85712-2152
Country	:	US
Telephone Number	:	520-881-8161
Fax Number	:	520-881-8163

Authorized Official
Title or Position	:	PRESIDENT/DERMATOLOGIST
Name	:	DR. MARC IRWIN EPSTEIN
Credential	:	D.O.
Telephone Number	:	520-881-8161

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	12/17/2012

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