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General NPI Number Information
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NPI Number | 1265431456
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS DERMATOPATHOLOGY LAB PA
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 1122 AUSTIN HWY
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4844
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Country | US
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Telephone | 210-342-6488
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Fax | 210-342-6725
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Provider Business Mailing Address
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Address Line | 1122 AUSTIN HWY
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4844
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Country | US
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Telephone | 210-342-6488
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Fax | 210-342-6725
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | MR. THOMAS L DAVIS
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Credential | MD
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Telephone | 210-342-6488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | G4960
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License Number State | TX
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