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General NPI Number Information
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NPI Number | 1134588148
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Entity Type | Organization
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Legal Business Name | LEGACY DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 1360 DEER LAKE DR
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City | FRISCO
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State | TX
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Zip | 75034-1731
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Country | US
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Telephone | 214-799-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 3140 LEGACY DR SUITE 110
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City | FRISCO
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State | TX
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Zip | 75034
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Country | US
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Telephone | 972-469-2626
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER WARNER DHARAMSI
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Credential | M.D.
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Telephone | 972-469-2626
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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 | P2228
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License Number State | TX
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