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General NPI Number Information
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NPI Number | 1679905673
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY OF EAST TEXAS PA
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 909 ESE LOOP323 STE 110
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City | TYLER
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State | TX
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Zip | 75701-9675
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Country | US
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Telephone | 903-531-2850
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Fax | 903-531-2875
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Provider Business Mailing Address
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Address Line | 909 E SE LOOP 323 STE 110
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City | TYLER
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State | TX
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Zip | 75701-9675
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Country | US
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Telephone | 903-531-2850
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Fax | 903-531-2875
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Authorized Official
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Title or Position | COO
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Name | KYLE DAVID JENKINS
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Credential |
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Telephone | 903-531-2850
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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 | TX
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