Organization
PHOENIX SURGICAL DERMATOLOGY GROUP LLC
Active
Organization
PHOENIX SURGICAL DERMATOLOGY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMIN FATHI MD (OWNER)
(480) 666-5568
Entity
Organization
Contact information
Practice address
4550 E BELL RD BLDG 5, PHOENIX, AZ 85032-9390
(480) 666-5568
(702) 297-6238
Mailing address
4550 E BELL RD BLDG 5, PHOENIX, AZ 85032-9390
(480) 666-5568
(702) 297-6238
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
02/24/2020
Last updated
02/29/2020
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