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General NPI Number Information
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NPI Number | 1023255254
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY & PLASTIC SURGERY ASSOCIATION, INC.
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 3115 PINE AVE SUITE 908
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City | WACO
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State | TX
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Zip | 76708-3247
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Country | US
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Telephone | 254-752-2575
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Fax | 254-752-0188
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Provider Business Mailing Address
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Address Line | 3115 PINE AVE SUITE 908
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City | WACO
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State | TX
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Zip | 76708-3247
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Country | US
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Telephone | 254-752-2575
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Fax | 254-752-0188
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT A.M. GARDERE
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Credential | M.D.
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Telephone | 254-752-2575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E7938
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License Number State | TX
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