Provider Demographics
NPI:1093958183
Name:DERMATOLOGY & SKIN SURGERY
Entity Type:Organization
Organization Name:DERMATOLOGY & SKIN SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTICIONER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-491-4092
Mailing Address - Street 1:2760 VIRGINIA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4964
Mailing Address - Country:US
Mailing Address - Phone:214-491-4092
Mailing Address - Fax:
Practice Address - Street 1:2760 VIRGINIA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4964
Practice Address - Country:US
Practice Address - Phone:214-491-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0314261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG76545Medicare UPIN