Provider Demographics
NPI:1568878247
Name:ROCKWALL DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:ROCKWALL DERMATOLOGY PLLC
Other - Org Name:ROCKWALL DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SAUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-377-1700
Mailing Address - Street 1:2701 SUNSET RIDGE DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0005
Mailing Address - Country:US
Mailing Address - Phone:469-377-1700
Mailing Address - Fax:469-377-1709
Practice Address - Street 1:2701 SUNSET RIDGE DR
Practice Address - Street 2:SUITE 404
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-0005
Practice Address - Country:US
Practice Address - Phone:469-377-1700
Practice Address - Fax:469-377-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2921207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377616Medicare PIN