Healthcare Provider Details

I. General information

NPI: 1649800848
Provider Name (Legal Business Name): SKIN CANCER DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7979 BROADWAY STE 202
SAN ANTONIO TX
78209-2657
US

IV. Provider business mailing address

7979 BROADWAY STE 202
SAN ANTONIO TX
78209-2657
US

V. Phone/Fax

Practice location:
  • Phone: 210-601-6502
  • Fax: 210-908-9666
Mailing address:
  • Phone: 210-601-6502
  • Fax: 210-908-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CALVIN L DAY
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 210-601-6502