Provider Demographics
NPI:1093031106
Name:TEXAS SKIN SURGERY CENTER, P.A.
Entity Type:Organization
Organization Name:TEXAS SKIN SURGERY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MARTINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-564-0947
Mailing Address - Street 1:4332 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1064
Mailing Address - Country:US
Mailing Address - Phone:214-564-0947
Mailing Address - Fax:
Practice Address - Street 1:4716 ALLIANCE BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:214-564-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8826261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty