Southwest Mobile Dermatology PLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SOUTHWEST MOBILE DERMATOLOGY PLC

Practice address

11034 N 23Rd Dr # 105B
Phoenix, AZ 85029-4743

Phone

(480) 330-5840

NPI assigned

Oct 4, 2019

Organization subpart

No

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

Authorized official

Name

John Stathakis, DO

Title

Owner

Phone

(602) 672-3675

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570147200000",
    "number": "1881235489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11034 N 23RD DR # 105B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294743",
            "telephone_number": "480-330-5840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11034 N 23RD DR # 105B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294743",
            "telephone_number": "480-330-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MOBILE DERMATOLOGY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-04",
        "last_updated": "2019-10-04",
        "status": "A",
        "authorized_official_last_name": "STATHAKIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-672-3675",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; 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.