Provider Demographics
NPI:1285990127
Name:DERMATIQUE, LTD
Entity type:Organization
Organization Name:DERMATIQUE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-619-5540
Mailing Address - Street 1:6900 E CAMELBACK RD
Mailing Address - Street 2:CAMELBACK TOWER, SUITE 900
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-453-1518
Practice Address - Street 1:6900 E CAMELBACK RD
Practice Address - Street 2:CAMELBACK TOWER, SUITE 900
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2431
Practice Address - Country:US
Practice Address - Phone:480-619-5540
Practice Address - Fax:888-453-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty