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General NPI Number Information
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NPI Number | 1992949564
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Entity Type | Organization
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Legal Business Name | SURGICAL DERMATOLOGY ASSOCIATES
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 4851 S I 35 E SUITE 101
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City | CORINTH
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State | TX
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Zip | 76210-2348
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Country | US
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Telephone | 940-591-0900
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Fax | 940-220-6444
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Provider Business Mailing Address
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Address Line | 4851 S I 35 E SUITE 101
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City | CORINTH
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State | TX
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Zip | 76210-2348
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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 | VICE PRESIDENT
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Name | DR. JENNIFER BETH PERONE
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Credential | M.D.
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Telephone | 646-554-6324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 41532
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License Number State | TX
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