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General NPI Number Information
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NPI Number | 1467826131
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Entity Type | Organization
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Legal Business Name | MEDICA SKIN DIAGNOSTICS PLLC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 2046 BEDFORD RD
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City | BEDFORD
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State | TX
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Zip | 76021-5709
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Country | US
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Telephone | 936-443-7504
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Fax |
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Provider Business Mailing Address
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Address Line | 126 COLLEGE ST S
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City | KELLER
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State | TX
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Zip | 76248-2316
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Country | US
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Telephone | 936-443-7504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYDIA ESSARY
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Credential | M.D.
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Telephone | 936-443-7504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | K8136
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License Number State | TX
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