MEDICARE: DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT

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	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician
2	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1831334291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT

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

Provider Business Practice Location Address
First Line	:	3101 HIGHWAY 71 E
Second Line	:	#201
City	:	BASTROP
State	:	TX
Zip	:	78602-5156
Country	:	US
Telephone Number	:	512-451-0139
Fax Number	:	512-323-5880

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DANIEL JOSEPH LADD JR.
Credential	:	D.O.
Telephone Number	:	512-451-0139

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	07/11/2019

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