MEDICARE: DERM DOCS PLLC

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	174400000X	Specialist	F9812	TX

General Provider Information

NPI Number	:	1114049152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERM DOCS PLLC

Provider Business Mailing Address
First Line	:	13722 EMBASSY ROW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2000
Country	:	US
Telephone Number	:	210-349-5577
Fax Number	:	210-349-5628

Provider Business Practice Location Address
First Line	:	1007 NE LOOP 410
Second Line	:	SUITE 110
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1205
Country	:	US
Telephone Number	:	210-826-3258
Fax Number	:	210-826-5520

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. BERNARD T. SWIFT JR.
Credential	:	D.O.
Telephone Number	:	210-349-5577

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/10/2007

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