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General NPI Number Information
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NPI Number | 1962219535
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Entity Type | Organization
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Legal Business Name | BLUE RIBBON DERMATOLOGY PLLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1150 N WATTERS RD STE 105
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City | ALLEN
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State | TX
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Zip | 75013-5536
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Country | US
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Telephone | 469-331-3242
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Fax | 469-331-3243
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Provider Business Mailing Address
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Address Line | 1150 N WATTERS RD STE 105
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City | ALLEN
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State | TX
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Zip | 75013-5536
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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 | PHYSICIAN
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Name | DR. NADER ABOUL-FETTOUH
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Credential | MD
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Telephone | 469-331-3242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery 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 | 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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