South Tyler Dermatology
Specialist in Tyler, TX. Organization (NPI-2).
NPI number1568661908
StatusActive
Last updated in NPPESJul 16, 2007
Details
- NPI
- 1568661908
- Entity type
- Organization (NPI-2)
- Legal business name
- South Tyler Dermatology
- Organization subpart
- No
- Enumeration date
- Jul 16, 2007
- Last updated
- Jul 16, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | H2238 | TX | Yes |
Practice location
5791 Copeland RdTyler, TX 75703-3905
Phone 903-509-2020 · Fax 903-509-2355
Mailing address
5791 Copeland RdTyler, TX 75703-3905
Phone 903-509-2020 · Fax 903-509-2355
Authorized official
Dannise Beckley
Physcian/ Owner
9035092020
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