Provider Demographics
NPI:1306839816
Name:DERMATOLOGICAL ASSOCIATION OF TEXAS, PLLC
Entity Type:Organization
Organization Name:DERMATOLOGICAL ASSOCIATION OF TEXAS, PLLC
Other - Org Name:DERMATOLOGICAL ASSOCIATION OF TEXAS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:TYRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-528-8818
Mailing Address - Street 1:1401 BINZ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:713-528-8818
Mailing Address - Fax:713-528-8848
Practice Address - Street 1:1401 BINZ
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-528-8818
Practice Address - Fax:713-528-8848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DERMATOLOGICAL ASSOCIATION OF TEXAS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-30
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5714207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27159Medicare UPIN