NPIMap

Organization Active NPI

Palm Canyon Dermatology, PC

  • Point of Service
  • Yuma, AZ
National Provider Identifier
1437339470
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
19732 Issued in AZ
Legal business name
PALM CANYON DERMATOLOGY, PC
Practice address
350 W Catalina Dr
Yuma, AZ 85364-8112
Phone
(928) 344-0650
Fax
(928) 344-3928
NPI assigned
Nov 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

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

Authorized official

Name
Mr. Gregory Andrew Ertl, M.D.
Title
President/Owner
Phone
(928) 344-0650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X 19732 AZ Primary

Addresses

Primary practice location

350 W Catalina Dr
Yuma, AZ 85364-8112

Mailing address

350 W Catalina Dr
Yuma, AZ 85364-8112
Phone (928) 344-0650

Other identifiers 1

IdentifierTypeStateIssuer
CG5646OtherRAIL ROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

12460 N Rancho Vistoso Blvd
Oro Valley, AZ 85755
Phone (520) 575-0800

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/4374/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1437339470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W CATALINA DR",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853648112",
            "telephone_number": "928-344-0650",
            "fax_number": "928-344-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W CATALINA DR",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853648112",
            "telephone_number": "928-344-0650",
            "fax_number": "928-344-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM CANYON DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "ERTL",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "928-344-0650",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "AZ",
            "license": "19732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CG5646",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.