| NPI | 1225567704 |
|---|---|
| Former Legal Business Name | LAKE TRAVIS DERMATOLOGY PA |
| Entity Type | Organization |
| Authorized Contact | ADRIENNE M FEASEL President 512-345-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX L2883) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-07-21 |