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General NPI Number Information
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NPI Number | 1770901589
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Entity Type | Organization
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Legal Business Name | WESTGATE SKIN & CANCER, PLLC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 2559 WESTERN TRAILS BLVD SUITE 301
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City | AUSTIN
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State | TX
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Zip | 78745-1565
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Country | US
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Telephone | 512-815-2559
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Fax | 888-419-8625
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Provider Business Mailing Address
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Address Line | 2559 WESTERN TRAILS BLVD SUITE 301
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City | AUSTIN
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State | TX
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Zip | 78745-1565
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Country | US
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Telephone | 512-815-2559
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Fax | 888-419-8625
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Authorized Official
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Title or Position | PHYSICIAN-ONWNER
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Name | DR. BLAKELY S. RICHARDSON
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Credential | D.O.
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Telephone | 214-499-1036
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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 | P7024
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License Number State | TX
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