1578727947 NPI number — ALL DERMATOLOGY, INC.

Table of content: (NPI 1578727947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578727947 NPI number — ALL DERMATOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL DERMATOLOGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLERGY AND DERMATOLOGY SPECIALISTS, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578727947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14239 W BELL RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SUPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85374-2469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-544-7755
Provider Business Mailing Address Fax Number:
623-544-8665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6320A W UNION HILLS DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-7177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-376-7600
Provider Business Practice Location Address Fax Number:
623-376-0229
Provider Enumeration Date:
07/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEHOUSHEK
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
623-376-7600

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NI0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NP0225X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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