NPIMap

Organization Active NPI

Southwest Skin & Cancer Institute

  • Dermatology Physician
  • Prescott, AZ
National Provider Identifier
1679774749
Registry record updated Sep 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
31062AZ Issued in AZ
Legal business name
SOUTHWEST SKIN & CANCER INSTITUTE
Practice address
242 Whipple Street
Prescott, AZ 86301-1787
Phone
(928) 778-0808
NPI assigned
May 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2008

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

Authorized official

Name
Robin Fleck, MDNPI 1598784563
Title
President
Phone
(928) 778-0808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 31062AZ AZ Primary

Addresses

Primary practice location

242 Whipple Street
Prescott, AZ 86301-1787

Mailing address

242 Whipple Street
Prescott, AZ 86301-1787
Phone (928) 778-0808

National Provider Directory

National Provider Directory

Locations

242 Whipple St
Prescott, AZ 86301
Phone (928) 778-0808

Practitioners & affiliated clinicians

Practitioners 1

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": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221004800000",
    "number": "1679774749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 WHIPPLE STREET",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011787",
            "telephone_number": "928-778-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 WHIPPLE STREET",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011787",
            "telephone_number": "928-778-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST SKIN & CANCER INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "FLECK",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-778-0808",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "31062AZ",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; 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.