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General NPI Number Information
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NPI Number | 1659656759
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Entity Type | Organization
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Legal Business Name | LIBERTY DERMATOLOGY, PA
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/10/2021
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Provider Practice Location Address
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Address Line | 7105 LAKEVIEW PKWY STE 100
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City | ROWLETT
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State | TX
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Zip | 75088-4202
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Country | US
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Telephone | 972-475-5300
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Fax | 972-475-5303
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Provider Business Mailing Address
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Address Line | PO BOX 601799
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City | DALLAS
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State | TX
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Zip | 75360-1799
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Country | US
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Telephone | 214-893-9677
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Fax | 972-475-5303
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIEN T. TRAN
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Credential | MD
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Telephone | 214-893-9677
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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 | N3356
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License Number State | TX
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