Provider Demographics
NPI:1376014464
Name:BAYOU CITY DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:BAYOU CITY DERMATOLOGY, LLC
Other - Org Name:BAYOU CITY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-406-1846
Mailing Address - Street 1:202 N TEXAS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4967
Mailing Address - Country:US
Mailing Address - Phone:346-406-1846
Mailing Address - Fax:346-406-1786
Practice Address - Street 1:750 N TEXAS AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4934
Practice Address - Country:US
Practice Address - Phone:346-406-1846
Practice Address - Fax:346-406-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty