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General NPI Number Information
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NPI Number | 1659132389
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Entity Type | Organization
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Legal Business Name | SKYLINE DERMATOLOGY PLLC
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 120 CHRIS KELLEY BLVD STE 100
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City | HUTTO
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State | TX
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Zip | 78634-5359
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Country | US
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Telephone | 737-231-1855
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Fax | 737-221-5662
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Provider Business Mailing Address
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Address Line | 120 CHRIS KELLEY BLVD STE 100
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City | HUTTO
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State | TX
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Zip | 78634-5359
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Country | US
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Telephone | 512-870-8383
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Fax | 737-221-5662
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Authorized Official
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Title or Position | OWNER
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Name | JOHNNY ZHAO
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Credential | MD
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Telephone | 737-231-1855
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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 |
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License Number State |
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