=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528932548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPIRE DERMATOLOGY AND SKIN SURGERY CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2025
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10298 WALDEN ST
-----------------------------------------------------
City | SODDY DAISY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37379-5152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-684-1330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10298 WALDEN ST
-----------------------------------------------------
City | SODDY DAISY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37379-5152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LUKE MAXFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-201-3373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------