Healthcare Provider Details

I. General information

NPI: 1720097181
Provider Name (Legal Business Name): TEXARKANA DERMATOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 RICHMOND RD
TEXARKANA TX
75503-0705
US

IV. Provider business mailing address

3502 RICHMOND RD
TEXARKANA TX
75503-0705
US

V. Phone/Fax

Practice location:
  • Phone: 903-223-9911
  • Fax:
Mailing address:
  • Phone: 903-223-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberK2257
License Number StateTX

VIII. Authorized Official

Name: KIMBERLY J PARHAM
Title or Position: OWNER
Credential: MD
Phone: 903-223-9911