Organization
NORTHERN ARIZONA DERMATOLOGY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYNTHIA ACKERMAN KNUTSON MD (CEO)
(928) 774-5074
Entity
Organization
Contact information
Practice address
1490 N TURQUOISE DR, FLAGSTAFF, AZ 86001
(928) 774-5074
(928) 779-0884
Mailing address
1490 N TURQUOISE DR, FLAGSTAFF, AZ 86001
(928) 774-5074
(928) 779-0884
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19361
AZ LICENSE
—
01
—
20368
AZ LICENSE
—
01
—
23222
AZ LICENSE
—
01
—
25924
AZ LICENSE
—
01
—
295114
AHCCCS
—
01
—
30215
AZ LICENSE
—
01
—
33121
AZ LICENSE
—
01
—
MICA010529
LIABILITY INSURANCE
—
01
—
MICA014013
LIABILITY INSURANCE
—
01
—
MICA03872
LIABILITY INSURANCE
—
01
—
MICA03874
LIABILITY INSURANCE
—
01
—
MICA03876
LIABILITY INSURANCE
—
01
—
MICA03976
LIABILITY INSURANCE
—
Enumeration date
01/26/2007
Last updated
03/07/2023
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