Provider Demographics
NPI:1568774735
Name:SKIN SURGERY OF SAN ANTONIO, PA
Entity Type:Organization
Organization Name:SKIN SURGERY OF SAN ANTONIO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-226-0040
Mailing Address - Street 1:2632 BROADWAY ST
Mailing Address - Street 2:201 SOUTH
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1137
Mailing Address - Country:US
Mailing Address - Phone:210-226-0040
Mailing Address - Fax:
Practice Address - Street 1:2632 BROADWAY ST
Practice Address - Street 2:201 SOUTH
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1137
Practice Address - Country:US
Practice Address - Phone:210-226-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty