NPIMap

Organization Active NPI

Pima Dermatology Office Based Surgery

  • Specialist
  • Tucson, AZ
National Provider Identifier
1376744847
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
11394 Issued in AZ
Legal business name
PIMA DERMATOLOGY OFFICE BASED SURGERY
Practice address
5150 E Glenn St
Tucson, AZ 85712-1337
Phone
(520) 795-7729
Fax
(520) 795-4177
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Gerald N Goldberg, M.D.
Title
Owner
Phone
(520) 795-7729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 11394 AZ Primary

Addresses

Primary practice location

5150 E Glenn St
Tucson, AZ 85712-1337

Mailing address

5150 E Glenn St
Tucson, AZ 85712-1337
Phone (520) 795-7729

National Provider Directory

National Provider Directory

Locations

5150 E Glenn St
Tucson, AZ 85712
Phone (520) 795-7729

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376744847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 E GLENN ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857121337",
            "telephone_number": "520-795-7729",
            "fax_number": "520-795-4177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 E GLENN ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857121337",
            "telephone_number": "520-795-7729",
            "fax_number": "520-795-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIMA DERMATOLOGY OFFICE BASED SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-795-7729",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "11394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.