Provider Demographics
NPI:1366529836
Name:EAST VALLEY DERMATOLOGY CENTER
Entity type:Organization
Organization Name:EAST VALLEY DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:JANET
Authorized Official - Last Name:GEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-821-8888
Mailing Address - Street 1:1100 S DOBSON RD STE 223
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6160
Mailing Address - Country:US
Mailing Address - Phone:480-821-8888
Mailing Address - Fax:480-821-0888
Practice Address - Street 1:1100 S DOBSON RD STE 223
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6160
Practice Address - Country:US
Practice Address - Phone:480-821-8888
Practice Address - Fax:480-821-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72153Medicare PIN