Actinodermatology LTD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

7979 Issued in AZ

Legal business name

ACTINODERMATOLOGY LTD

Practice address

2600 E Southern Ave
#A-2
Tempe, AZ 85282-7610

Phone

(480) 839-1767

NPI assigned

Dec 11, 2007

Last updated

Apr 1, 2010By 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

Dr. Jerry A Ponitch, M.D.

Title

President

Phone

(480) 839-1767

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1063695252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHERN AVE",
            "address_2": "#A-2",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827610",
            "telephone_number": "480-839-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHERN AVE",
            "address_2": "#A-2",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827610",
            "telephone_number": "480-839-1767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTINODERMATOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "PONITCH",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-839-1767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "7979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; 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.