Individual
JONATHAN LAVIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2127 E BASELINE RD STE 104, TEMPE, AZ 85283-1537
(804) 556-0446
(480) 556-0447
Mailing address
13835 N TATUM BLVD STE 9-268, PHOENIX, AZ 85032-5590
(480) 418-3314
(480) 923-6586
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
66845
AZ
207ND0101X
MOHS-Micrographic Surgery Physician
66845
AZ
Other
Enumeration date
03/26/2017
Last updated
04/20/2025
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