Provider Demographics
NPI:1316010994
Name:PAULGER DERMATOLOGY AND SKIN CANCER CENTER, PA
Entity Type:Organization
Organization Name:PAULGER DERMATOLOGY AND SKIN CANCER CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAULGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-797-1202
Mailing Address - Street 1:2202 ITHACA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1332
Mailing Address - Country:US
Mailing Address - Phone:806-797-1202
Mailing Address - Fax:806-797-4854
Practice Address - Street 1:2202 ITHACA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1332
Practice Address - Country:US
Practice Address - Phone:806-797-1202
Practice Address - Fax:806-797-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM007456OtherBCBS NEW MEXICO
TX00774NOtherBCBS TEXAS
CG9770Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX00774NOtherBCBS TEXAS