Central Texas Dermatology, PA
Specialist in West Lake Hills, TX. Organization (NPI-2).
NPI number1164566246
StatusActive
Last updated in NPPESSep 13, 2023
Details
- NPI
- 1164566246
- Entity type
- Organization (NPI-2)
- Legal business name
- Central Texas Dermatology, PA
- Organization subpart
- No
- Enumeration date
- Feb 20, 2007
- Certification date
- Sep 13, 2023
- Last updated
- Sep 13, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | F4405 | TX | Yes |
Practice location
102 Westlake Dr#100
West Lake Hills, TX 78746
Phone 512-327-7779
Mailing address
102 Westlake DrSte 100
West Lake Hills, TX 78746-5373
Phone 512-327-7779
Authorized official
Debra Petrie
Biller/Credentialer
5123278449
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