| NPI | 1144398843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE F MCDONALD CEO 940-767-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K9351) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: TX K9351) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-08-22 |