Provider Demographics
NPI:1427428416
Name:SOUTHWEST SKIN & CANCER INSTITUTE LTD
Entity type:Organization
Organization Name:SOUTHWEST SKIN & CANCER INSTITUTE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-778-0808
Mailing Address - Street 1:242 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1787
Mailing Address - Country:US
Mailing Address - Phone:928-778-0808
Mailing Address - Fax:928-778-4788
Practice Address - Street 1:242 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1787
Practice Address - Country:US
Practice Address - Phone:928-778-0808
Practice Address - Fax:928-778-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31062207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty