White Mountain Dermatology LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

WHITE MOUNTAIN DERMATOLOGY LLC

Practice address

288 N Ironwood Dr
Suite 105
Apache Junction, AZ 85220-3830

Phone

(480) 671-4086

NPI assigned

May 23, 2006

Last updated

Apr 7, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gerardo C Brual, MD

Title

President

Phone

(480) 671-4086

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph S Machuzak, D.O.

  • Dermatology Physician
  • Tucson, AZ
  • NPI 1093959744
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1033164538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "288 N IRONWOOD DR",
            "address_2": "SUITE 105",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "852203830",
            "telephone_number": "480-671-4086",
            "fax_number": "480-671-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "288 N IRONWOOD DR",
            "address_2": "SUITE 105",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "852203830",
            "telephone_number": "480-671-4086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MOUNTAIN DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "BRUAL",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-671-4086",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "070013565",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Apache Junction, AZ
• Providers in Apache Junction, AZ by specialty
• Procedural Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.