Healthcare Provider Details

I. General information

NPI: 1942192596
Provider Name (Legal Business Name): PHYSICIANS DERMATOLOGY OF ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
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 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: CAROLINE CARR
Title or Position: OWNER
Credential: MD
Phone: 775-790-3667