Healthcare Provider Details

I. General information

NPI: 1174062673
Provider Name (Legal Business Name): CENTER FOR DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14275 N 87TH ST SUITE 109 & 110
SCOTTSDALE AZ
85260-3696
US

IV. Provider business mailing address

14275 N 87TH ST SUITE 109 & 110
SCOTTSDALE AZ
85260-3696
US

V. Phone/Fax

Practice location:
  • Phone: 480-905-8485
  • Fax: 480-905-7274
Mailing address:
  • Phone: 480-905-8485
  • Fax: 480-905-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6627
License Number StateAZ

VIII. Authorized Official

Name: GARY MCCRACKEN
Title or Position: OWNER/MEDICAL PROVIDER
Credential: MD
Phone: 480-905-8485