Provider Demographics
NPI:1447051461
Name:FOX DERMATOLOGY AND AESTHETICS LLC
Entity type:Organization
Organization Name:FOX DERMATOLOGY AND AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-516-7552
Mailing Address - Street 1:3514 N POWER RD STE 123
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2909
Mailing Address - Country:US
Mailing Address - Phone:480-319-9500
Mailing Address - Fax:480-319-9599
Practice Address - Street 1:3514 N POWER RD STE 123
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2909
Practice Address - Country:US
Practice Address - Phone:480-319-9500
Practice Address - Fax:480-319-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty