Innovative Dermatology Alliance Az, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INNOVATIVE DERMATOLOGY ALLIANCE AZ, PC

Practice address

390 Bralliar Rd
Wickenburg, AZ 85390

Phone

(602) 971-0268

NPI assigned

May 11, 2020

Organization subpart

No

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

Authorized official

Name

Christopher U Rex, MD

Title

Owner

Phone

(904) 994-4533

Specialties & licenses 1

Addresses

Electronic endpoints 2

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1215559471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3318 W LUCIA DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850835884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 BRALLIAR RD",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "85390",
            "telephone_number": "602-971-0268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DERMATOLOGY ALLIANCE AZ, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2023-11-27",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "REX",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-994-4533",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://ablcvisalia.com/",
            "affiliation": "Y",
            "affiliationName": "Innovative Dermatology Alliance CA",
            "address_1": "115 N Akers St",
            "city": "Visalia",
            "state": "CA",
            "country_code": "US",
            "postal_code": "932915122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://ablcvisalia.com/",
            "affiliation": "Y",
            "affiliationName": "Innovative Dermatology Alliance CA",
            "address_1": "115 N Akers St",
            "city": "Visalia",
            "state": "CA",
            "country_code": "US",
            "postal_code": "932915122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laurie Ann Henegar, PHARM.D.
• Alexa Hershkowitz, FNP-C
• Eduardo Rodolfo Huergo, M.D.
• Jodi Lee Hunt, SLPA
• Icore Radiology Inc
• Clyde Irons Jr.
• J & J Smiles
• Audrey Jacobsen, DPT
• Allison Jenner
• Joshua Heath Jones, D.M.D.

• Dermatology Physician in Wickenburg, AZ
• Providers in Wickenburg, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.