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General NPI Number Information
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NPI Number | 1992813570
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY SPECIALISTS, PA
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 3005 E. RENNER ROAD SUITE 100
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City | RICHARDSON
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State | TX
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Zip | 75082
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Country | US
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Telephone | 792-699-0000
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Fax | 972-699-0004
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Provider Business Mailing Address
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Address Line | 3005 E RENNER RD SUITE 100
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City | RICHARDSON
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State | TX
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Zip | 75082-3505
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Country | US
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Telephone | 972-699-0000
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Fax | 972-699-0004
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Authorized Official
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Title or Position | OFFICE MGR
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Name | SANDALEE S KRUEGER
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Credential |
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Telephone | 972-699-0000
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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 | L0877
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License Number State | TX
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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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