MEDICARE: DERMATOLOGY SPECIALISTS OF AUSTIN, P.A.

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	M2684	TX

General Provider Information

NPI Number	:	1427009687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY SPECIALISTS OF AUSTIN, P.A.

Provider Business Mailing Address
First Line	:	4300 N QUINLAN PARK RD
Second Line	:	SUITE 225
City	:	AUSTIN
State	:	TX
Zip	:	78732-6067
Country	:	US
Telephone Number	:	512-266-0007
Fax Number	:	512-266-0077

Provider Business Practice Location Address
First Line	:	4300 N QUINLAN PARK RD
Second Line	:	SUITE 225
City	:	AUSTIN
State	:	TX
Zip	:	78732-6067
Country	:	US
Telephone Number	:	512-266-0007
Fax Number	:	512-266-0077

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. EDWARD LEWIS LAIN
Credential	:	M.D.
Telephone Number	:	512-266-0007

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/29/2009

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