Organization
ARIZONA ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY, LLC
Active
Other names
Arizona Dermatology Group
Organization subpart
No
Provider details
NPI number
Authorized official
AMY FAJARDO (BILLING/CREDENTIALING)
(928) 777-5807
Entity
Organization
Contact information
Practice address
830 AINSWORTH DR, PRESCOTT, AZ 86301-1630
(928) 776-0325
(928) 776-0405
Mailing address
830 AINSWORTH DR, PRESCOTT, AZ 86301-1630
(928) 776-0325
(928) 776-0405
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
29683
AZ
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
29683
AZ
207ND0900X
Dermatopathology Physician
29683
AZ
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NS0135X
Procedural Dermatology Physician
29683
AZ
208200000X
Plastic Surgery Physician
48829
AZ
Other
Enumeration date
10/04/2006
Last updated
04/11/2019
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