MEDICARE: BAY AREA LASER SKIN CARE AND WELLNESS CENTER

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	207R00000X	Internal Medicine Physician	K2109	TX
2	208000000X	Pediatrics Physician	L6264	TX
3	363A00000X	Physician Assistant	PA01230	TX
4	207R00000X	Internal Medicine Physician	L6264	TX

General Provider Information

NPI Number	:	1316072929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA LASER SKIN CARE AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2925-B GULF FREEWAY SOUTH
Second Line	:	#386
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573
Country	:	US
Telephone Number	:	832-868-9313
Fax Number	:	832-422-9393

Provider Business Practice Location Address
First Line	:	1203 WEST BAY AREA BLVD.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77598
Country	:	US
Telephone Number	:	832-868-9313
Fax Number	:	832-422-9393

Authorized Official
Title or Position	:	CO-DIRECTOR
Name	:	DR. ERIC ROBERSON
Credential	:	MD
Telephone Number	:	832-868-9313

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	09/11/2025

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