Provider Demographics
NPI:1558513325
Name:DERMATOLOGY & SKIN CANCER CARE
Entity Type:Organization
Organization Name:DERMATOLOGY & SKIN CANCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-277-0430
Mailing Address - Street 1:14885 SOUTHWEST FWY
Mailing Address - Street 2:STE A101
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5016
Mailing Address - Country:US
Mailing Address - Phone:281-277-0430
Mailing Address - Fax:281-277-0491
Practice Address - Street 1:14885 SOUTHWEST FWY
Practice Address - Street 2:STE A101
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5016
Practice Address - Country:US
Practice Address - Phone:281-277-0430
Practice Address - Fax:281-277-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5109207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0187Medicare PIN