Organization
ARIZONA SKIN & DERMATOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANNTEJ SRA M.D. (CEO)
(602) 529-4700
Entity
Organization
Contact information
Practice address
7200 W BELL RD, SUITE E103, GLENDALE, AZ 85308-8529
(602) 529-4700
(602) 529-4699
Mailing address
8380 W EMILE ZOLA AVE, SUITE 5116, PEORIA, AZ 85381-4811
(602) 529-4700
(602) 529-4699
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z171303
MEDICARE PTAN
AZ
Enumeration date
09/04/2014
Last updated
01/23/2015
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