Organization
BINGHAM DERMATOLOGY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY KEMPTON BINGHAM D.O. (OWNER / MANAGING MEMBER)
(111) 111-1111
Entity
Organization
Contact information
Practice address
2855 E BROWN RD, SUITE 22, MESA, AZ 85213-4213
(111) 111-1111
Mailing address
2855 E BROWN RD, SUITE 22, MESA, AZ 85213-4213
(111) 111-1111
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5198
AZ
Other
Enumeration date
03/28/2013
Last updated
03/28/2013
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