=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114480837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCTORS DERMATOLOGY AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2019
-----------------------------------------------------
Last Update Date | 07/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2605 W TRENTON RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-803-0180
-----------------------------------------------------
Fax | 956-253-7463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2605 W TRENTON RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-803-0180
-----------------------------------------------------
Fax | 956-253-7463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ZEESHAN AFZAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-803-0180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------