Healthcare Provider Details

I. General information

NPI: 1700953510
Provider Name (Legal Business Name): DERMATOLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MEDICAL PKWY SUITE 105
DALLAS TX
75234-7858
US

IV. Provider business mailing address

9 MEDICAL PKWY SUITE 105
DALLAS TX
75234-7858
US

V. Phone/Fax

Practice location:
  • Phone: 972-243-4530
  • Fax: 972-406-1950
Mailing address:
  • Phone: 972-243-4530
  • Fax: 972-406-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDY COOK
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 972-243-4530