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NPI Code Detail

MEDICARE: GLOW DERMATOLOGY, PLLC

MEDICARE: GLOW DERMATOLOGY, PLLC
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
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1437810629
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLOW DERMATOLOGY, PLLC
Provider Business Mailing Address
First Line : 10 S BRIAR HOLLOW LN UNIT 61
Second Line :
City : HOUSTON
State : TX
Zip : 77027-2894
Country : US
Telephone Number : 337-258-0428
Fax Number :
Provider Business Practice Location Address
First Line : 6815 N MAIN ST STE A
Second Line :
City : HOUSTON
State : TX
Zip : 77009-1039
Country : US
Telephone Number : 337-258-0428
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. MONEE THOMAS
Credential : MD
Telephone Number : 337-258-0428
Provider Enumeration Date : 01/10/2022
Last Update Date : 01/10/2022

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Directions to “GLOW DERMATOLOGY, PLLC ” Practice Location

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