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General NPI Number Information
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NPI Number | 1194792416
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Entity Type | Organization
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Legal Business Name | CENTER FOR DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 03/06/2006
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 14275 N 87TH ST SUITE 110
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3696
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Country | US
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Telephone | 480-905-8485
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Fax | 480-905-7274
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Provider Business Mailing Address
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Address Line | 14275 N 87TH ST SUITE 110
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3696
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Country | US
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Telephone | 480-905-8485
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Fax | 480-905-7274
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GARY ANTHONY MCCRACKEN
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Credential | MD
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Telephone | 480-905-8485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 45164
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 48145
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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