Provider Demographics
NPI:1053871384
Name:OCOTILLO DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:OCOTILLO DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ALLGEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-625-7975
Mailing Address - Street 1:1805 W SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-5172
Mailing Address - Country:US
Mailing Address - Phone:480-625-7975
Mailing Address - Fax:
Practice Address - Street 1:3930 S ALMA SCHOOL RD STE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4510
Practice Address - Country:US
Practice Address - Phone:480-917-4815
Practice Address - Fax:480-963-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ707265Medicaid