Organization
WHITE MOUNTAIN DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERARDO C BRUAL MD (PRESIDENT)
(480) 671-4086
Entity
Organization
Contact information
Practice address
288 N IRONWOOD DR, SUITE 105, APACHE JUNCTION, AZ 85220-3830
(480) 671-4086
Mailing address
288 N IRONWOOD DR, SUITE 105, APACHE JUNCTION, AZ 85220-3830
(480) 671-4086
(480) 671-4105
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070013565
RAIL ROAD MEDICARE
AZ
Enumeration date
05/23/2006
Last updated
04/07/2015
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