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General NPI Number Information
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NPI Number | 1053029348
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Entity Type | Organization
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Legal Business Name | BARE DERM GROUP INC
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 2110 RESEARCH ROW STE 310
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City | DALLAS
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State | TX
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Zip | 75235-2534
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Country | US
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Telephone | 972-797-9297
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Fax | 972-330-8808
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Provider Business Mailing Address
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Address Line | 1005 W RALPH HALL PKWY STE 207
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City | ROCKWALL
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State | TX
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Zip | 75032-6662
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Country | US
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Telephone | 972-483-9228
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Fax | 972-433-6128
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER HALPIN
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Credential |
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Telephone | 972-483-9228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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