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General NPI Number Information
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NPI Number | 1780045260
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Entity Type | Organization
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Legal Business Name | LAKEWOOD DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 6162 E MOCKINGBIRD LN STE. 120
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City | DALLAS
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State | TX
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Zip | 75214-2697
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Country | US
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Telephone | 214-463-8328
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Fax |
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Provider Business Mailing Address
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Address Line | 6162 E MOCKINGBIRD LN STE. 120
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City | DALLAS
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State | TX
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Zip | 75214-2697
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Country | US
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Telephone | 214-463-8328
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK HENRY MCDONOUGH
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Credential | MD
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Telephone | 214-463-8328
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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 | Q6655
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License Number State | TX
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