MEDICARE: BEL-AMI DERMATOLOGY

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760540348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEL-AMI DERMATOLOGY

Provider Business Mailing Address
First Line	:	3123 GREEN MEADOW DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6977
Country	:	US
Telephone Number	:	325-944-3376
Fax Number	:	325-944-3306

Provider Business Practice Location Address
First Line	:	3123 GREEN MEADOW DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6977
Country	:	US
Telephone Number	:	325-944-3376
Fax Number	:	325-944-3306

Authorized Official
Title or Position	:	M.D.
Name	:	KAY A JOHNSTON
Credential	:
Telephone Number	:	325-944-3376

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/22/2020

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Directions to “BEL-AMI DERMATOLOGY ” Practice Location

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