Provider Demographics
NPI:1992061162
Name:ARIZONA DERMATOLOGY SPECIALISTS, PLLC
Entity type:Organization
Organization Name:ARIZONA DERMATOLOGY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-793-8411
Mailing Address - Street 1:P.O. BOX 9290
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9290
Mailing Address - Country:US
Mailing Address - Phone:623-584-3376
Mailing Address - Fax:623-584-3375
Practice Address - Street 1:14800 W. MOUNTAIN VIEW BLVD.
Practice Address - Street 2:STE. 160
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2700
Practice Address - Country:US
Practice Address - Phone:623-584-3376
Practice Address - Fax:623-584-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29708207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ721358Medicaid
AZP17495542OtherAZ PLLC REGISTRATION