MEDICARE: DERMATOLOGY & SKIN SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	K0314	TX

General Provider Information

NPI Number	:	1093958183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY & SKIN SURGERY

Provider Business Mailing Address
First Line	:	2760 VIRGINIA PKWY STE 200
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4964
Country	:	US
Telephone Number	:	214-491-4092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2760 VIRGINIA PKWY STE 200
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4964
Country	:	US
Telephone Number	:	214-491-4092
Fax Number	:

Authorized Official
Title or Position	:	SOLO PRACTICIONER/ OWNER
Name	:	DR. GINA G. HARNEY
Credential	:	M.D.
Telephone Number	:	214-491-4092

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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