Basic Information
| Provider Information | |||||||||
| NPI: | 1326040965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KESSLER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | EMERSON | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 S 63RD ST | ||||||||
| Address2: | BLDG 3 SUITE 114 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812888 | ||||||||
| FaxNumber: | 4806540599 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 S 63RD ST | ||||||||
| Address2: | BLDG 3 SUITE 114 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812888 | ||||||||
| FaxNumber: | 4806540599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 1730 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | 1730 | AZ | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207NS0135X | 1730 | AZ | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 257354 | 05 | AZ | MEDICAID |