Machuzak Dermatology PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MACHUZAK DERMATOLOGY PLLC

Practice address

3198 N Windsong Dr
Prescott Valley, AZ 86314-2239

Phone

(928) 202-4143

Fax

(928) 233-8917

NPI assigned

Feb 16, 2019

Organization subpart

No

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

Authorized official

Name

Debra Moreland

Title

Practice Manager

Phone

(480) 621-2070

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• JM Dermatology Doing business as

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

{
    "created_epoch": "1550275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1922564707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3198 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142239",
            "telephone_number": "928-202-4143",
            "fax_number": "928-233-8917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3198 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142239",
            "telephone_number": "928-202-4143",
            "fax_number": "928-233-8917"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3124 Willow Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863016610",
            "country_code": "US",
            "telephone_number": "928-202-4143",
            "fax_number": "928-233-8917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MACHUZAK DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-16",
        "last_updated": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "MORELAND",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "480-621-2070"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "453107",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JM Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JM Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany L Luce, M.D.
• Dinah Leigh Lunsford
• Yingqiao Luo
• Lisa Lynn Lusk
• M & M Eye Institute, PLC
• Jennifer Macias
• Michael G Macon, M.D.
• Scott Madsen, P.T.
• Claudia Adriana Magda
• Patrick James Mahaney, MD

• Specialist in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.