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Organization

ACTINODERMATOLOGY LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JERRY A PONITCH M.D. (PRESIDENT)
(480) 839-1767
Entity
Organization

Contact information

Practice address
2600 E SOUTHERN AVE, #A-2, TEMPE, AZ 85282-7610
(480) 839-1767
Mailing address
2600 E SOUTHERN AVE, #A-2, TEMPE, AZ 85282-7610
(480) 839-1767

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
7979
AZ

Other

Enumeration date
12/11/2007
Last updated
04/01/2010
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