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General NPI Number Information
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NPI Number | 1487277737
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Entity Type | Organization
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Legal Business Name | WISE DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 13333 DOTSON RD STE 140
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City | HOUSTON
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State | TX
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Zip | 77070-4305
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Country | US
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Telephone | 281-975-0585
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Fax | 281-975-0584
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Provider Business Mailing Address
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Address Line | 13333 DOTSON RD STE 140
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City | HOUSTON
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State | TX
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Zip | 77070-4305
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Country | US
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Telephone | 281-975-0585
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Fax | 281-975-0584
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW SEWELL
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Credential | MD
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Telephone | 281-975-0585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology 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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