Organization
SOUTHWEST MOBILE DERMATOLOGY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN STATHAKIS DO (OWNER)
(602) 672-3675
Entity
Organization
Contact information
Practice address
11034 N 23RD DR # 105B, PHOENIX, AZ 85029-4743
(480) 330-5840
Mailing address
11034 N 23RD DR # 105B, PHOENIX, AZ 85029-4743
(480) 330-5840
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
10/04/2019
Last updated
10/04/2019
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