Healthcare Provider Details

I. General information

NPI: 1033283619
Provider Name (Legal Business Name): BAYLOR COLLEGE OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 TAUB LOOP DEPT. OF DERMATOLOGY
HOUSTON TX
77030-1608
US

IV. Provider business mailing address

2 E GREENWAY PLZ SUITE 900
HOUSTON TX
77046-0297
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-3713
  • Fax:
Mailing address:
  • Phone: 713-798-1835
  • 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: JOHN R. NICKENS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 713-798-1710