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General NPI Number Information
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NPI Number | 1609251107
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Entity Type | Organization
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Legal Business Name | SOUTHWEST SKIN AND VEIN CENTER PLLC
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Dates
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Enumeration Date | 07/25/2015
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 4544 S LAMAR BLVD STE 640
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City | AUSTIN
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State | TX
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Zip | 78745-1500
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Country | US
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Telephone | 512-444-7208
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Fax | 512-444-2343
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Provider Business Mailing Address
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Address Line | 4544 S LAMAR BLVD STE 640
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City | AUSTIN
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State | TX
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Zip | 78745-1500
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Country | US
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Telephone | 512-444-7208
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Fax |
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Authorized Official
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Title or Position | OWNER MD
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Name | MICHAEL GRAVES
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Credential |
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Telephone | 512-444-7208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | Q3000
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License Number State | TX
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