Provider Demographics
NPI:1225110984
Name:UT PHYSICIANS
Entity Type:Organization
Organization Name:UT PHYSICIANS
Other - Org Name:UT PHYSICIANS- DERMATOPATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAPINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-500-8334
Mailing Address - Street 1:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:6655 TRAVIS ST
Practice Address - Street 2:980
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1312
Practice Address - Country:US
Practice Address - Phone:713-500-8334
Practice Address - Fax:713-500-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140416257Medicaid
TXCL8371Medicare PIN