Provider Demographics
NPI:1417434119
Name:DERMATOLOGY SPECIALISTS OF FORT WORTH PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY SPECIALISTS OF FORT WORTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-498-3974
Mailing Address - Street 1:6131 SOUTHWEST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1047
Mailing Address - Country:US
Mailing Address - Phone:817-989-1221
Mailing Address - Fax:
Practice Address - Street 1:6131 SOUTHWEST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-1047
Practice Address - Country:US
Practice Address - Phone:817-989-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty