Healthcare Provider Details

I. General information

NPI: 1194060343
Provider Name (Legal Business Name): METROPOLITAN DERMATOLOGY INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 WESTHEIMER RD SUITE 300
HOUSTON TX
77027-5015
US

IV. Provider business mailing address

4055 WESTHEIMER RD SUITE 300
HOUSTON TX
77027-5015
US

V. Phone/Fax

Practice location:
  • Phone: 713-955-1333
  • Fax: 713-955-1331
Mailing address:
  • Phone: 713-955-1333
  • Fax: 713-955-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM8326
License Number StateTX

VIII. Authorized Official

Name: JENNIFER M SEGAL
Title or Position: OWNER
Credential: MD
Phone: 713-955-1333