Provider Demographics
NPI:1528364304
Name:DERMATOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-521-1969
Mailing Address - Street 1:PO BOX 268988
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8988
Mailing Address - Country:US
Mailing Address - Phone:405-608-4494
Mailing Address - Fax:405-608-4504
Practice Address - Street 1:3727 NW 63RD ST STE 205
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1923
Practice Address - Country:US
Practice Address - Phone:405-608-4494
Practice Address - Fax:405-608-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA0463Medicare UPIN