| Prescott Medical And Dermatology Group | |
|
804 Ainsworth Dr Ste 105 Prescott AZ 86301-1624 | |
| (602) 476-4074 | |
| Not Available |
| Full Name | Prescott Medical And Dermatology Group |
|---|---|
| Speciality | Family Medicine |
| Location | 804 Ainsworth Dr Ste 105, Prescott, Arizona |
| Authorized Official Name and Position | Amy Fajardo (BILLING/CREDENTIALING) |
| Authorized Official Contact | 4806789893 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prescott Medical And Dermatology Group 804 Ainsworth Dr Ste 105 Prescott AZ 86301-1624 Ph: (602) 476-4074 | Prescott Medical And Dermatology Group 804 Ainsworth Dr Ste 105 Prescott AZ 86301-1624 Ph: (602) 476-4074 |
| NPI Number | 1841929908 |
|---|---|
| Provider Enumeration Date | 06/06/2022 |
| Last Update Date | 06/06/2022 |
| Medicare PECOS PAC ID | 4688057201 |
|---|---|
| Medicare Enrollment ID | O20220815002698 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841929908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Burt I Faibisoff |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1730128695 PECOS PAC ID: 3274568290 Enrollment ID: I20050928001143 |
| Provider Name | Charles H Johnson |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1336129667 PECOS PAC ID: 2769401801 Enrollment ID: I20080128000446 |
| Provider Name | Dean Stokes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639173370 PECOS PAC ID: 7719935774 Enrollment ID: I20120601000420 |
| Provider Name | Shelly Lynn Crossman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295167484 PECOS PAC ID: 5395061451 Enrollment ID: I20180814001139 |
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