Provider Demographics
NPI:1164950317
Name:HOUSTON DERMATOLOGY AND PLASTIC SURGERY
Entity Type:Organization
Organization Name:HOUSTON DERMATOLOGY AND PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-313-0555
Mailing Address - Street 1:16926 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2350
Mailing Address - Country:US
Mailing Address - Phone:281-995-3295
Mailing Address - Fax:
Practice Address - Street 1:3030 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7633
Practice Address - Country:US
Practice Address - Phone:281-313-0555
Practice Address - Fax:281-313-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty