Organization
ARIZONA SKIN SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E. B. JOHNSON MD (OWNER)
(602) 482-1300
Entity
Organization
Contact information
Practice address
16620 N 40TH ST, STE I-5, PHOENIX, AZ 85032-3348
(602) 482-1300
Mailing address
16620 N 40TH ST, STE I-5, PHOENIX, AZ 85032-3348
(602) 482-1300
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
24917
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K3265
MEDICAL LICENSE
TX
01
—
MD0000031574
MEDICAL LICENSE
TN
Enumeration date
06/22/2006
Last updated
04/26/2011
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