Provider Demographics
NPI:1104810720
Name:PEHOUSHEK, JAMES FREDERICK (MD MPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
Last Name:PEHOUSHEK
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14239 W BELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2469
Mailing Address - Country:US
Mailing Address - Phone:623-544-7755
Mailing Address - Fax:623-544-8665
Practice Address - Street 1:6320-A W UNION HILLS DR.
Practice Address - Street 2:STE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1051
Practice Address - Country:US
Practice Address - Phone:623-376-7600
Practice Address - Fax:623-376-0229
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23095207N00000X, 207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI00632Medicare UPIN
AZZ80756Medicare PIN
AZZ80754Medicare PIN