1831334291 NPI number — DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT

Table of content: (NPI 1831334291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831334291 NPI number — DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT
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:
1831334291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 JEFFERSON ST
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-6224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-451-0139
Provider Business Mailing Address Fax Number:
512-323-5880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 HIGHWAY 71 E
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-5156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-451-0139
Provider Business Practice Location Address Fax Number:
512-323-5880
Provider Enumeration Date:
12/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LADD
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
512-451-0139

Provider Taxonomy Codes

  • Taxonomy code: 207WX0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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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