Provider Demographics
NPI:1407041114
Name:LAS COLINAS DERMATOLOGY PA
Entity Type:Organization
Organization Name:LAS COLINAS DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-432-0300
Mailing Address - Street 1:440 W IH 635 FWY
Mailing Address - Street 2:365
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3768
Mailing Address - Country:US
Mailing Address - Phone:972-432-0300
Mailing Address - Fax:972-432-0874
Practice Address - Street 1:440 W IH 635 FWY
Practice Address - Street 2:365
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3768
Practice Address - Country:US
Practice Address - Phone:972-432-0300
Practice Address - Fax:972-432-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1878207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T26ZMedicare PIN