Healthcare Provider Details

I. General information

NPI: 1285488312
Provider Name (Legal Business Name): HORIZON DERMATOLOGY AND SKIN SURGERY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10298 WALDEN ST
SODDY DAISY TN
37379-5152
US

IV. Provider business mailing address

10298 WALDEN ST
SODDY DAISY TN
37379-5152
US

V. Phone/Fax

Practice location:
  • Phone: 415-802-1310
  • Fax: 412-712-8567
Mailing address:
  • Phone: 415-802-1310
  • Fax: 412-712-8567

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

VIII. Authorized Official

Name: LUKE MAXFIELD
Title or Position: OWNER
Credential: MD
Phone: 415-802-1310