1306839816 NPI number — DERMATOLOGICAL ASSOCIATION OF TEXAS, PLLC

Table of content: (NPI 1306839816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306839816 NPI number — DERMATOLOGICAL ASSOCIATION OF TEXAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGICAL ASSOCIATION OF TEXAS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DERMATOLOGICAL ASSOCIATION OF TEXAS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306839816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 BINZ
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-528-8818
Provider Business Mailing Address Fax Number:
713-528-8848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 BINZ
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-528-8818
Provider Business Practice Location Address Fax Number:
713-528-8848
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TYRING
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
713-528-8818

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  G5714 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com