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General NPI Number Information
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NPI Number | 1699735878
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Entity Type | Organization
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Legal Business Name | BELLAIRE DERMATOLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 6565 WEST LOOP S STE. 800
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City | BELLAIRE
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State | TX
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Zip | 77401-3500
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Country | US
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Telephone | 713-661-4383
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Fax | 713-661-4346
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Provider Business Mailing Address
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Address Line | 6565 WEST LOOP S STE. 800
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City | BELLAIRE
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State | TX
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Zip | 77401-3500
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Country | US
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Telephone | 713-661-4383
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Fax | 713-661-4346
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG F TELLER
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Credential | M.D.
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Telephone | 832-553-2318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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