Organization
CLEAR SKY DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN SVANCARA DO (OWNER/PHYSICIAN)
(623) 853-3762
Entity
Organization
Contact information
Practice address
2620 N 140TH AVE STE 103, GOODYEAR, AZ 85395-2437
(623) 219-4777
Mailing address
17620 W COLUMBINE DR, SURPRISE, AZ 85388-5623
(623) 853-3762
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
006549
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006549
MEDICAL LICENSE NUMBER
AZ
Enumeration date
07/25/2017
Last updated
03/22/2023
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