MEDICARE: TRUE DERMATOLOGY DFW, 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

General Provider Information

NPI Number	:	1235644972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE DERMATOLOGY DFW, PLLC

Provider Business Mailing Address
First Line	:	6170 RESEARCH RD STE 109
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-3508
Country	:	US
Telephone Number	:	972-635-3401
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 WATTERS CREEK BLVD
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-3734
Country	:	US
Telephone Number	:	972-635-3400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRYAN LOWERY
Credential	:	MD
Telephone Number	:	972-635-3402

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	01/25/2018

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