MEDICARE: LADERA PARK DERMATOLOGY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001MU	OTHER	TX	BLUE CROSS GROUP NUMBER

General Provider Information

NPI Number	:	1417010935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADERA PARK DERMATOLOGY, P.A.

Provider Business Mailing Address
First Line	:	11671 JOLLYVILLE RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4141
Country	:	US
Telephone Number	:	512-345-3599
Fax Number	:	512-345-3928

Provider Business Practice Location Address
First Line	:	11671 JOLLYVILLE RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4141
Country	:	US
Telephone Number	:	512-345-3599
Fax Number	:	512-345-3928

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANET C DUBOIS
Credential	:	MD
Telephone Number	:	512-345-3599

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/27/2013

Similar Medicare Providers

1427153568 — DEIRDRE M RHOAD M.D.
Practice Location Address:

11671 JOLLYVILLE RD STE 103
AUSTIN, TX
78759-4141

Practice Phone: 512-476-9149
Practice Fax: 512-476-8654

1215084546 — DR. BLAIR ANDREW BRADFORD DMD
Practice Location Address:

11671 JOLLYVILLE RD STE 201
AUSTIN, TX
78759-4141

Practice Phone: 512-249-7668
Practice Fax: 512-219-1246

1699064766 — DUSTYN ERIK WILLIAMS MD
Practice Location Address:

11671 JOLLYVILLE RD STE 202
AUSTIN, TX
78759-4141

Practice Phone: 512-343-9848
Practice Fax: 877-296-2908

1104239615 — KACIE MARIE CULOTTA D.M.D.
Practice Location Address:

11671 JOLLYVILLE RD STE 204
AUSTIN, TX
78759-4141

Practice Phone: 512-345-9973
Practice Fax:

1225567704 — LADERA PARK DERMATOLOGY PA
Practice Location Address:

11671 JOLLYVILLE RD STE 104
AUSTIN, TX
78759-4141

Practice Phone: 512-345-3599
Practice Fax: 512-345-3928

1205433455 — CHALKIAS CARDIOLOGY PLLC
Practice Location Address:

11671 JOLLYVILLE RD STE 120
AUSTIN, TX
78759-4141

Practice Phone: 512-675-6098
Practice Fax:

Directions to “LADERA PARK DERMATOLOGY, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.