Provider Demographics
NPI:1033325550
Name:BAYTOWN DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:BAYTOWN DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONNER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-425-9375
Mailing Address - Street 1:3730 EMMETT HUTTO BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-1764
Mailing Address - Country:US
Mailing Address - Phone:281-425-9375
Mailing Address - Fax:281-427-4584
Practice Address - Street 1:3730 EMMETT HUTTO BLVD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-1764
Practice Address - Country:US
Practice Address - Phone:281-425-9375
Practice Address - Fax:281-427-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3267207N00000X
TX45D0496518207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038BHOtherBCBS
TXDG4065OtherRAILROAD MEDICARE
TX0038BHMedicare PIN