Provider Demographics
NPI:1326362054
Name:SAN ANTONIO SKIN CARE AND DERMATOLOGY CLINIC, PA
Entity Type:Organization
Organization Name:SAN ANTONIO SKIN CARE AND DERMATOLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-9494
Mailing Address - Street 1:7434 LOUIS PASTEUR
Mailing Address - Street 2:STE. 220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4538
Mailing Address - Country:US
Mailing Address - Phone:210-615-9494
Mailing Address - Fax:210-615-1514
Practice Address - Street 1:7434 LOUIS PASTEUR
Practice Address - Street 2:STE. 220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4538
Practice Address - Country:US
Practice Address - Phone:210-615-9494
Practice Address - Fax:210-615-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty