Organization
PRESCOTT MEDICAL AND DERMATOLOGY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BURT I FAIBISOFF MD (PHYSICIAN/OWNER)
(602) 476-4074
Entity
Organization
Contact information
Practice address
810 AINSWORTH DR, PRESCOTT, AZ 86301-1612
(928) 515-1155
(928) 460-5158
Mailing address
810 AINSWORTH DR, PRESCOTT, AZ 86301-1612
(928) 515-1155
(928) 460-5158
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Enumeration date
06/06/2022
Last updated
11/10/2025
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