MEDICARE: PARK CITIES 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	207NS0135X	Procedural Dermatology Physician

General Provider Information

NPI Number	:	1871527531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK CITIES DERMATOLOGY, PA

Provider Business Mailing Address
First Line	:	PO BOX 610429
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75261-0429
Country	:	US
Telephone Number	:	214-373-7546
Fax Number	:	214-373-7545

Provider Business Practice Location Address
First Line	:	4420 W LOVERS LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3130
Country	:	US
Telephone Number	:	214-373-7546
Fax Number	:	214-373-7545

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARK TURNER
Credential	:
Telephone Number	:	214-373-7546

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/11/2025

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Directions to “PARK CITIES DERMATOLOGY, PA ” Practice Location

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