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General NPI Number Information
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NPI Number | 1578135539
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Entity Type | Organization
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Legal Business Name | JUNIPER DERMATOLOGY PLLC
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Dates
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Enumeration Date | 07/10/2021
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 3801 N CAPITAL OF TEXAS HWY STE J225
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City | AUSTIN
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State | TX
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Zip | 78746-1499
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Country | US
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Telephone | 805-453-6060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1030
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City | SANTA YNEZ
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State | CA
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Zip | 93460-1030
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Country | US
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Telephone | 512-808-4777
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Fax | 512-808-4779
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRYAN GAMMON
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Credential | MD
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Telephone | 512-808-4777
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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 | 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 #3
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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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