MEDICARE: ADVANCED ASSOCIATES IN DERMATOLOGY, 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	207N00000X	Dermatology Physician	M9017	TX

General Provider Information

NPI Number	:	1134447949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ASSOCIATES IN DERMATOLOGY, PLLC

Provider Business Mailing Address
First Line	:	440 RAYFORD RD
Second Line	:	SUITE 140
City	:	SPRING
State	:	TX
Zip	:	77386-1918
Country	:	US
Telephone Number	:	281-385-8189
Fax Number	:	281-203-5037

Provider Business Practice Location Address
First Line	:	440 RAYFORD RD
Second Line	:	SUITE 140
City	:	SPRING
State	:	TX
Zip	:	77386-1918
Country	:	US
Telephone Number	:	281-385-8189
Fax Number	:	281-203-5037

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TEMITOPE FELIX SOARES
Credential	:	M.D.
Telephone Number	:	281-385-8189

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	01/19/2011

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