Physician Skin Solutions

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

04-805 Issued in AZ

Legal business name

PHYSICIAN SKIN SOLUTIONS

Doing business as

Physician Skin at Arrowhead

Practice address

18275 N 59TH Ave
Suite C-116
Glendale, AZ 85308-1260

Phone

(602) 843-4040

Fax

(602) 843-4077

NPI assigned

May 7, 2015

Last updated

May 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

Mrs. Shannon Leah Maltais, NMD

Title

Ceo/Medical Director

Phone

(602) 843-4040

Specialties & licenses 1

Addresses

Other names 1

• Physician Skin at Arrowhead Doing business as

Locations

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1225416456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18275 N 59TH AVE",
            "address_2": "SUITE C-116",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081260",
            "telephone_number": "602-843-4040",
            "fax_number": "602-843-4077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18275 N 59TH AVE",
            "address_2": "SUITE C-116",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081260",
            "telephone_number": "602-843-4040",
            "fax_number": "602-843-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SKIN SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-07",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "MALTAIS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "LEAH",
        "authorized_official_title_or_position": "CEO/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "602-843-4040",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NMD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "04-805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physician Skin at Arrowhead",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

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