Provider Demographics
NPI:1508046541
Name:DERMATOLOGY CLINIC, PA
Entity Type:Organization
Organization Name:DERMATOLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:SWINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-784-5727
Mailing Address - Street 1:2510 STILLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-2024
Mailing Address - Country:US
Mailing Address - Phone:903-784-5727
Mailing Address - Fax:
Practice Address - Street 1:2510 STILLHOUSE RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-2024
Practice Address - Country:US
Practice Address - Phone:903-784-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-1075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXEJ87Medicare PIN