MEDICARE: FOX DERMATOLOGY AND AESTHETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207ND0101X	MOHS-Micrographic Surgery Physician
2	207NS0135X	Procedural Dermatology Physician
3	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1447051461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX DERMATOLOGY AND AESTHETICS LLC

Provider Business Mailing Address
First Line	:	3514 N POWER RD STE 123
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-2909
Country	:	US
Telephone Number	:	480-319-9500
Fax Number	:	480-319-9599

Provider Business Practice Location Address
First Line	:	3514 N POWER RD STE 123
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-2909
Country	:	US
Telephone Number	:	480-319-9500
Fax Number	:	480-319-9599

Authorized Official
Title or Position	:	PA-C/OWNER
Name	:	MS. CARLIE FOX
Credential	:	PA-C
Telephone Number	:	480-516-7552

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/24/2025

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