MEDICARE: ALLURE DERMATOLOGY PA

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	207NP0225X	Pediatric Dermatology Physician
2	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1780029462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLURE DERMATOLOGY PA

Provider Business Mailing Address
First Line	:	PO BOX 4869
Second Line	:	DEPARTMENT #455
City	:	HOUSTON
State	:	TX
Zip	:	77210-4869
Country	:	US
Telephone Number	:	956-630-3376
Fax Number	:	956-630-0046

Provider Business Practice Location Address
First Line	:	1201 E RIDGE RD STE E
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-1532
Country	:	US
Telephone Number	:	956-630-3376
Fax Number	:	956-630-0046

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NORMA MAGEE
Credential	:	MD
Telephone Number	:	956-630-3376

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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