Provider Demographics
NPI:1316016710
Name:BRYKERWOOD SKIN AND VEIN CENTER PA
Entity Type:Organization
Organization Name:BRYKERWOOD SKIN AND VEIN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACULEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-302-4047
Mailing Address - Street 1:1600 W 38TH STREET
Mailing Address - Street 2:SUITE 315
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-302-4047
Mailing Address - Fax:512-302-1629
Practice Address - Street 1:1600 W 38TH STREET
Practice Address - Street 2:SUITE 315
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-302-4047
Practice Address - Fax:512-302-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXJ4761207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0051DROtherBCBS
00396JMedicare ID - Type Unspecified
F73064Medicare UPIN