Healthcare Provider Details

I. General information

NPI: 1184148355
Provider Name (Legal Business Name): THRIVE FAMILY DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 S WATTERS RD STE 120
ALLEN TX
75013-5123
US

IV. Provider business mailing address

PO BOX 1019
ALLEN TX
75013-0017
US

V. Phone/Fax

Practice location:
  • Phone: 972-649-6999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA VAWTER
Title or Position: MD
Credential: MD
Phone: 972-954-5573