Healthcare Provider Details

I. General information

NPI: 1104973684
Provider Name (Legal Business Name): BAYLOR HAIR CENTER PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 GASTON AVE SUITE 1058 WADLEY TOWER
DALLAS TX
75246-1800
US

IV. Provider business mailing address

3600 GASTON AVE SUITE 1058 WADLEY TOWER
DALLAS TX
75246-1800
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-4247
  • Fax: 214-821-3873
Mailing address:
  • Phone: 214-820-4247
  • Fax: 214-821-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberF2110
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberF2110
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID A WHITING
Title or Position: OWNER
Credential: MD
Phone: 214-820-4247