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NPI Code Detail

MEDICARE: DERMATOLOGY & CUTANEOUS SURGERY PLLC

MEDICARE: DERMATOLOGY & CUTANEOUS SURGERY 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
1207N00000XDermatology PhysicianTX

General Provider Information

NPI Number : 1245540202
Entity Type Code : Organization
Provider Name (Legal Business Name) : DERMATOLOGY & CUTANEOUS SURGERY PLLC
Provider Business Mailing Address
First Line : 8015 S COOPER ST
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-7018
Country : US
Telephone Number : 817-453-4440
Fax Number : 817-453-7755
Provider Business Practice Location Address
First Line : 8015 S COOPER ST
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-7018
Country : US
Telephone Number : 817-453-4440
Fax Number : 817-453-7755
Authorized Official
Title or Position : PHYSICIAN
Name : VICTORIA WATT SERRALTA
Credential : MD
Telephone Number : 817-453-4440
Provider Enumeration Date : 10/08/2010
Last Update Date : 06/27/2011

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Directions to “DERMATOLOGY & CUTANEOUS SURGERY PLLC ” Practice Location

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