| NPI | 1053640151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA WYATT President 928-779-6923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 42581) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: AZ 42581) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: AZ 42581) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: AZ 42581) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 42581) | |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2019-01-15 |