Provider Demographics
NPI:1114049152
Name:DERM DOCS PLLC
Entity Type:Organization
Organization Name:DERM DOCS PLLC
Other - Org Name:THE DERMATOLOGY CENTER AT TEXAS MEDCLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:210-349-5577
Mailing Address - Street 1:13722 EMBASSY ROW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2000
Mailing Address - Country:US
Mailing Address - Phone:210-349-5577
Mailing Address - Fax:210-349-5628
Practice Address - Street 1:1007 NE LOOP 410
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1205
Practice Address - Country:US
Practice Address - Phone:210-826-3258
Practice Address - Fax:210-826-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9812174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W259Medicare ID - Type UnspecifiedMEDICARE GROUP ID