Healthcare Provider Details

I. General information

NPI: 1356791461
Provider Name (Legal Business Name): CAROLINE CARR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20542 N LAKE PLEASANT RD STE 105
PEORIA AZ
85382-9749
US

IV. Provider business mailing address

20542 N LAKE PLEASANT RD STE 105
PEORIA AZ
85382-9749
US

V. Phone/Fax

Practice location:
  • Phone: 623-404-0155
  • Fax: 623-404-0229
Mailing address:
  • Phone: 623-404-0155
  • Fax: 623-404-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number61175
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number61175
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: