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General NPI Number Information
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NPI Number | 1124710363
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Entity Type | Organization
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Legal Business Name | BLUE STAR DERMATOLOGY & AESTHETICS MANAGEMENT LLC
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 3800 GAYLORD PKWY STE 1080
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City | FRISCO
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State | TX
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Zip | 75034-9416
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Country | US
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Telephone | 972-497-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COWBOYS WAY STE 100
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City | FRISCO
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State | TX
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Zip | 75034-1977
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Country | US
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Telephone | 972-497-4153
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | REID THOMAS MCSWIGGAN
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Credential | NONE
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Telephone | 972-497-4153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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