| NPI | 1124840244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE STEPHENS Practice Administrator 469-553-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2024-10-29 |
| Last Update Date | 2024-11-13 |