Provider Demographics
NPI:1255686465
Name:CLEAR LAKE DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:CLEAR LAKE DERMATOLOGY, PLLC
Other - Org Name:CLEAR LAKE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:APISARNTHANARAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-332-9681
Mailing Address - Street 1:13938 HIGHWAY 3 UNIT 100
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1622
Mailing Address - Country:US
Mailing Address - Phone:281-332-9681
Mailing Address - Fax:281-332-5957
Practice Address - Street 1:13938 HIGHWAY 3 UNIT 100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1622
Practice Address - Country:US
Practice Address - Phone:281-332-9681
Practice Address - Fax:281-332-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty