Provider Demographics
NPI:1174730147
Name:AAP DERMATOLOGY & COSMETIC SURGERY, P.C.
Entity type:Organization
Organization Name:AAP DERMATOLOGY & COSMETIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-924-9235
Mailing Address - Street 1:3940 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6945
Mailing Address - Country:US
Mailing Address - Phone:480-924-9235
Mailing Address - Fax:480-832-5501
Practice Address - Street 1:3940 E UNIVERSITY DR
Practice Address - Street 2:SUITE ONE
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6945
Practice Address - Country:US
Practice Address - Phone:480-924-9235
Practice Address - Fax:480-832-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2012207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118024Medicare PIN