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General NPI Number Information
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NPI Number | 1164244703
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Entity Type | Organization
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Legal Business Name | WELLWORX DERMATOLOGY PLLC
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 5899 PRESTON RD STE 804
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City | FRISCO
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State | TX
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Zip | 75034-9586
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Country | US
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Telephone | 682-268-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 4516 LAKOTA TRL
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City | MANSFIELD
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State | TX
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Zip | 76063-2312
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Country | US
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Telephone | 817-718-3571
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | RYAN PHAM
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Credential | DO
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Telephone | 817-718-3571
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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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