Lynn Leroy Juracek, MD
Dermatology, MOHS-Micrographic Surgery in Surprise, AZ. Individual provider (NPI-1).
NPI number1083608699
StatusActive
Last updated in NPPESMay 15, 2013
Details
- NPI
- 1083608699
- Entity type
- Individual (NPI-1)
- Name
- Lynn Leroy Juracek
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 9, 2005
- Last updated
- May 15, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207ND0101X | Dermatology, MOHS-Micrographic Surgery | 30022 | AZ | Yes |
| 207N00000X | Dermatology | 30022 | AZ | |
| 207NI0002X | Dermatology, Clinical & Laboratory Dermatological Immunology | 30022 | AZ | |
| 207NS0135X | Dermatology, Procedural Dermatology | 30022 | AZ | |
| 207ND0900X | Dermatology, Dermatopathology | 30022 | AZ | |
| 207NP0225X | Dermatology, Pediatric Dermatology | 30022 | AZ |
Practice location
14239 W Bell RdSuite 101
Surprise, AZ 85374-2469
Phone 623-544-7755 · Fax 623-544-8665
Mailing address
14239 W Bell RdSuite 101
Surprise, AZ 85374-2469
Phone 623-544-7755 · Fax 623-544-8665
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