1255407441 NPI number — MOUNTAIN VIEW DERMATOLOGY,P.A.

Table of content: (NPI 1255407441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255407441 NPI number — MOUNTAIN VIEW DERMATOLOGY,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN VIEW DERMATOLOGY,P.A.
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:
Provider Other Organization Name Type Code:
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:
1255407441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 ZION LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79904-3531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-759-7700
Provider Business Mailing Address Fax Number:
915-759-7778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8820 GATEWAY BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79904-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-759-7700
Provider Business Practice Location Address Fax Number:
915-759-7778
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VINSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT, MT VIEW DERMATOLOGY, P.A
Authorized Official Telephone Number:
915-759-7700

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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