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General NPI Number Information
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NPI Number | 1518939347
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Entity Type | Organization
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Legal Business Name | WESTLAKE DERMATOLOGY PA
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 8825 BEE CAVE RD SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78746-4719
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Country | US
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Telephone | 512-328-3376
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Fax | 512-306-0222
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Provider Business Mailing Address
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Address Line | 8825 BEE CAVE RD SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78746-4719
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Country | US
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Telephone | 512-328-3376
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Fax | 512-306-0222
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY A NIKOLAIDIS
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Credential | MD
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Telephone | 512-328-3376
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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 |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State | TX
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Taxonomy #4
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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 | TX
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Taxonomy #5
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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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