Provider Demographics
NPI:1124002837
Name:BAYLOR DERMATOPATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:BAYLOR DERMATOPATHOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-481-3544
Mailing Address - Street 1:PO BOX 4715
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4715
Mailing Address - Country:US
Mailing Address - Phone:713-481-3544
Mailing Address - Fax:
Practice Address - Street 1:6535 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-798-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX690900004OtherRAILROAD MEDICARE
TXCL0260Medicare ID - Type UnspecifiedGROUP NUMBER