| NPI | 1215291414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SENAIT W DYSON Owner 520-838-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 41383) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 41383) |
| 207ND0900X Dermatology Dermatopathology (Licence: AZ 41383) | |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: AZ 41383) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: AZ 41383) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: AZ 41383) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2013-07-01 |