WHITE MOUNTAIN DERMATOLOGY LLC (NPI# 1033164538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033164538 |
| Entity Type | Organization |
| Organization Name | WHITE MOUNTAIN DERMATOLOGY LLC |
| Practice Address |
288 N Ironwood Dr Suite 105 Apache Junction AZ 85220-3830 |
| Practice Telephone | 4806714086 |
| Mailing Telephone | 4806714086 |
| Mailing Fax Number | 4806714105 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2015-04-07 |
| Authorized Official Name | GERARDO C BRUAL (PRESIDENT) |
| Authorized Official Telephone | 4806714086 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | RAIL ROAD MEDICARE | 070013565 | 01 |
| Street Address |
288 N IRONWOOD DR SUITE 105 |
| City | APACHE JUNCTION |
| State | AZ |
| Zip Code | 85220-3830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225022148 | Russell Vernon Pearson | Social Worker | 288 N Ironwood Dr, Apache Junction, AZ 85220-3830 | 2005-09-07 |
| 1730637281 | Arizona Skin and Laser Therapy Institute, Ltd | Dermatology | 288 N Ironwood Dr, Suite 105, Apache Junction, AZ 85120-3830 | 2016-09-13 |
| 1609228451 | Raquel Ramirez | Counselor | 288 N Ironwood Dr, Apache Junction, AZ 85120-3830 | 2016-07-05 |
| 1255780953 | Willisha Tucker | Counselor | 288 N Ironwood Dr, Apache Junction, AZ 85120-3830 | 2016-06-03 |
| 1245495209 | Daniel E. Parke | Social Worker | 288 N Ironwood Dr, Apache Junction, AZ 85220-3830 | 2008-07-18 |
| 1578721056 | Mercy Rd.chiropractic,p.l.l.c. | Clinic/Center | 288 N Ironwood Dr, #108-109, Apache Junction, AZ 85120-3830 | 2008-05-30 |
| 1902084551 | Stacey L. Atkins | Counselor | 288 N Ironwood Dr, Suite 110, Apache Junction, AZ 85120-3830 | 2008-02-06 |
| 1437284353 | Charlie Mitchell, Ph.d. P.C. | Psychologist | 288 N Ironwood Dr, #110, Apache Junction, AZ 85220-3830 | 2007-02-22 |
| 1750416673 | Merril Heslop | Social Worker | 288 N Ironwood Dr, 110, Apache Junction, AZ 85220-3830 | 2007-02-22 |
| 1568533024 | George Christopher Berry | Psychologist | 288 N Ironwood Dr, Suite 110, Apache Junction, AZ 85220-3830 | 2006-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144598996 | Amelia Shah | Pharmacist | 185 W Apache Trail, Apache Junction, AZ 85220 | 2011-12-08 |
| 1528280153 | Archish Arvind Patel | Pharmacist | 185 W. Apache Tr., Apache Junction, AZ 85220 | 2007-05-03 |
| 1629298476 | Jill Diane Gottschalk | Pharmacist | Fry's Pharmacy, 185 W Apache Trail, Apache Junction, AZ 85220 | 2007-04-26 |
| 1194847814 | Assisted Living Concepts Inc | Assisted Living Facility | 675 West Broadway, Apache Junction, AZ 85220 | 2007-04-04 |
| 1467517177 | Lora A Andrews | Physical Therapist | 10241 E Apache Trail, Apache Junction, AZ 85220 | 2006-12-22 |
| 1043372097 | Jill Elizabeth Russo | Technician | 2017 S Thunderbird Dr, Apache Junction, AZ 85220 | 2006-12-15 |
| 1053490029 | Kenneth K Leung | Internal Medicine | 2066 W Apache Trail #110, Apache Junction, AZ 85220 | 2006-11-02 |
| 1508831025 | Paula Ann Crinklaw | Nurse Practitioner | 1485 W Frontier St, Apache Junction, AZ 85220 | 2006-02-19 |
| 1033433826 | Innovative Health Partners LLC | Hospitalist | 2050 W Southern Ave, Apache Junction, AZ 85220 | 2010-03-23 |
| 1194048660 | Innovative Inpatient Services PC | Hospitalist | 2050 W Southern Ave, Apache Junction, AZ 85220 | 2010-03-11 |
| Find all providers in zip 85220 | ||||
| Taxonomy Code | 207NS0135X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Procedural Dermatology |
| Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). |
| Notes: Source: American Board of Dermatology, 2007, www.abderm.org [1/1/2008: definition added, source added, title changed] Additional Resources: Some ABMS board certified dermatologists have completed a one-year ACGME approved fellowship in Procedural Dermatology, which has been offered since 2003. At this time the ABD does not offer subspecialty certification in Procedural Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871051383 | Skin Deep Aesthetics, LLC | Dermatology | 1714 W Guadalupe Rd Ste 201, Gilbert, AZ 85233-2943 | 2019-03-05 |
| 1982819397 | Tamra Whiteley-myers Md PC | Dermatology | 5190 E Farness Dr Ste 110, Tucson, AZ 85712-2142 | 2007-05-11 |
| 1871653840 | Cynthia Jean Modny | Dermatology | 2402 E San Miguel Ave, Phoenix, AZ 85016-2815 | 2006-12-11 |
| 1518928878 | Mark A Meyers | Dermatology | 715 S Beeline Hwy, Ste A, Payson, AZ 85541-5344 | 2006-03-28 |
| 1235128851 | Andrew S. Tedesco | Dermatology | 6648 E Carondelet Dr, Tucson, AZ 85710-2119 | 2005-10-17 |
| 1861498297 | Keith Andrew Mackenzie | Dermatology | 3190 Clearwater Dr, Prescott, AZ 86305-7131 | 2005-06-21 |
| 1083066450 | Arizona Skin and Laser Therapy Institue, Ltd | Dermatology | 16620 N 40th St, Suite C-3, Phoenix, AZ 85032-3348 | 2016-07-08 |
| 1548634348 | La Peau Dermatology LLC | Dermatology | 5424 E Southern Ave, Suite 103, Mesa, AZ 85206-3621 | 2015-11-17 |
| 1972861326 | Ryan Mark Proctor | Dermatology | 3015 Hway 95, Suite 110, Bullhead City, AZ 86442-4334 | 2012-04-23 |
| 1427340389 | Brenda Latowsky M.d. P.l.c. | Dermatology | 12251 N 32nd St, Phoenix, AZ 85032-7189 | 2011-05-11 |
| Find all providers with the same taxonomy | ||||
| City | APACHE JUNCTION |
| Zip Code | 85220 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.