MEDICARE: HOUSTON DERMATOLOGY ASSOCIATES PA

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1104917384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON DERMATOLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 1720
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2735
Country	:	US
Telephone Number	:	713-790-0058
Fax Number	:	713-790-0410

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 1720
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2735
Country	:	US
Telephone Number	:	713-790-0058
Fax Number	:	713-790-0410

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FARAH SHAH
Credential	:	MD
Telephone Number	:	713-790-0058

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/04/2024

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