| NPI | 1912418963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON L BLASER President 903-593-9474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K9734) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: TX K9734) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |