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General NPI Number Information
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NPI Number | 1851720056
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Entity Type | Organization
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Legal Business Name | PREMIER DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 1525 HICKORY ST
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City | ABILENE
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State | TX
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Zip | 79601-2906
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Country | US
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Telephone | 325-677-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 HICKORY ST
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City | ABILENE
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State | TX
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Zip | 79601-2906
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Country | US
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Telephone | 325-677-7546
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Fax | 325-676-7546
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES LANDERO
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Credential | D.O.
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Telephone | 325-677-7546
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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 | N8206
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License Number State | TX
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