Provider Demographics
NPI:1063004810
Name:BAYSHORE DERMATOLOGY CLINIC
Entity Type:Organization
Organization Name:BAYSHORE DERMATOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-946-2666
Mailing Address - Street 1:3901 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1956
Mailing Address - Country:US
Mailing Address - Phone:713-946-2666
Mailing Address - Fax:713-946-1655
Practice Address - Street 1:3901 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1956
Practice Address - Country:US
Practice Address - Phone:713-946-2666
Practice Address - Fax:713-946-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty