Provider Demographics
NPI:1487661518
Name:DERMATOLOGY ASSOCIATES OF SAN ANTONIO
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-657-9338
Mailing Address - Street 1:7832 PAT BOOKER ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2601
Mailing Address - Country:US
Mailing Address - Phone:210-657-9338
Mailing Address - Fax:210-293-1843
Practice Address - Street 1:7832 PAT BOOKER ROAD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2601
Practice Address - Country:US
Practice Address - Phone:210-657-9338
Practice Address - Fax:210-293-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F93YMedicare ID - Type Unspecified