Healthcare Provider Details

I. General information

NPI: 1447051461
Provider Name (Legal Business Name): FOX DERMATOLOGY AND AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 N POWER RD STE 123
MESA AZ
85215-2909
US

IV. Provider business mailing address

3514 N POWER RD STE 123
MESA AZ
85215-2909
US

V. Phone/Fax

Practice location:
  • Phone: 480-319-9500
  • Fax: 480-319-9599
Mailing address:
  • Phone: 480-319-9500
  • Fax: 480-319-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CARLIE FOX
Title or Position: PA-C/OWNER
Credential: PA-C
Phone: 480-516-7552