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General NPI Number Information
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NPI Number | 1396267332
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Entity Type | Organization
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Legal Business Name | MOUNTAIN WEST DERM - AUSTIN PLLC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4513 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78633-1302
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Country | US
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Telephone | 512-930-3909
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Fax | 512-240-5469
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Provider Business Mailing Address
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Address Line | 4513 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78633-1302
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Country | US
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Telephone | 512-930-3909
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Fax | 512-240-5469
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Authorized Official
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Title or Position | MD
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Name | SUKETU PATEL
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Credential |
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Telephone | 512-930-3909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic 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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