| NPI | 1942233895 |
|---|---|
| Other Name | SOUTHLAKE DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | ANGELA G BOWERS President 817-251-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX K0476) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-04-06 |