Arizona Skin and Laser Therapy Institute, LTD
Organization Active NPI Dermatology Physician · Gilbert, AZ
NPI 1760418008 · NPPES record last updated Jan 11, 2008
Key facts
- NPI
- 1760418008
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD
- Practice address
- 4001 E Baseline Rd
Suite B-8
Gilbert, AZ 85234-2726 - Phone
- (480) 844-0510
- Fax
- (480) 844-1663
- NPI assigned
- Jun 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Neil P Superfon, D.O.
- Title
- Owner/Physician
- Phone
- (602) 277-1449
Other NPIs on the same Medicare enrollment 9
Practitioners 4
-
Abby Baker, APRN, NP-C
-
Michael Lowell Crandall, M.D.
-
Elizabeth Nafornita, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209000424 | AZ | Part B Supplier - Clinic/Group Practice | 6204720626 |
Receives reassigned benefits from 17 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Apache Junction, AZ; Coolidge, AZ; Gilbert, AZ; Mesa, AZ; Phoenix, AZ; Quartzsite, AZ; Scottsdale, AZ; Show Low, AZ |
National Provider Directory
Locations
1500 S White Mountain Rd
Ste 401
Show Low, AZ 85901
Phone (928) 537-2550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
4001 E Baseline Rd
Suite B-8
Gilbert, AZ 85234-2726
Mailing address
2224 W Northern Ave
D 300
Phoenix, AZ 85021-4928
Phone (602) 277-1449
Other providers in Gilbert, AZ
- Arizona Physician'S Laboratory, LLC
- Arizona Proactive Health and Medicine
- Arizona Rehab Specialists,PLLC
- Arizona Restorative Psychiatry
- Arizona Services for Developmental Therapy Inc
- Arizona Smiile Center PLLC
- Arizona Smiles P.C.
- Arizona Smiles, P.C.
- Arizona Specialty Physicians
- Arizona Spine and Pain Specialists, LLC
All providers in Gilbert, AZ · Dermatology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.