MEDICARE: PHYSICIANS DERMATOLOGY OF ARIZONA PLLC

Medicare Provider Information

Scope of Practice

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

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

General Provider Information

NPI Number	:	1942192596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS DERMATOLOGY OF ARIZONA PLLC

Provider Business Mailing Address
First Line	:	20542 N LAKE PLEASANT RD STE 105
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-9749
Country	:	US
Telephone Number	:	623-404-0155
Fax Number	:	623-404-0229

Provider Business Practice Location Address
First Line	:	20542 N LAKE PLEASANT RD STE 105
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-9749
Country	:	US
Telephone Number	:	623-404-0155
Fax Number	:	623-404-0229

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLINE CARR
Credential	:	MD
Telephone Number	:	775-790-3667

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	01/28/2026

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