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General NPI Number Information
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NPI Number | 1609011154
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Entity Type | Organization
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Legal Business Name | DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 2 SAINT MARKS PL #110
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City | LA GRANGE
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State | TX
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Zip | 78945-1251
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Country | US
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Telephone | 512-451-0139
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Fax | 512-323-5880
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Provider Business Mailing Address
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Address Line | 3500 JEFFERSON ST #200
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City | AUSTIN
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State | TX
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Zip | 78731-6224
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Country | US
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Telephone | 512-451-0139
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Fax | 512-323-5880
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DANIEL JOSEPH LADD JR.
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Credential | D.O.
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Telephone | 512-451-0139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive 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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