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General NPI Number Information
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NPI Number | 1861362386
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Entity Type | Organization
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Legal Business Name | MISMO DERM AND WOUND TX ED PLLC
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 1303 AUTUMN MIST WAY
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City | ARLINGTON
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State | TX
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Zip | 76005-4533
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Country | US
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Telephone | 214-621-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 AUTUMN MIST WAY
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City | ARLINGTON
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State | TX
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Zip | 76005-4533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JAMISON FERAMISCO
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Credential | MD, PHD
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Telephone | 214-621-4303
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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 |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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