| NPI | 1578135539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN GAMMON Manager 512-808-4777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207ND0900X Dermatology, Dermatopathology | |
| Enumeration Date | 2021-07-10 |
| Last Update Date | 2023-08-14 |