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General NPI Number Information
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NPI Number | 1386215002
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Entity Type | Organization
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Legal Business Name | DERM TEXAS LLC
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Dates
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Enumeration Date | 07/03/2021
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 2110 RESEARCH ROW STE 100C
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City | DALLAS
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State | TX
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Zip | 75235-2519
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Country | US
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Telephone | 214-845-6426
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Fax | 214-845-7544
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Provider Business Mailing Address
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Address Line | 2110 RESEARCH ROW STE 100C
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City | DALLAS
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State | TX
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Zip | 75235-2519
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Country | US
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Telephone | 214-845-6426
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Fax | 214-845-7544
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Authorized Official
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Title or Position | MEMBER
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Name | KELLY WARREN
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Credential | MD
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Telephone | 727-221-6415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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