Provider Demographics
NPI:1598913253
Name:MANSFIELD DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:MANSFIELD DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-539-0959
Mailing Address - Street 1:2800 E BROAD ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6409
Mailing Address - Country:US
Mailing Address - Phone:817-539-0959
Mailing Address - Fax:817-539-0480
Practice Address - Street 1:2800 E BROAD ST
Practice Address - Street 2:SUITE 408
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6414
Practice Address - Country:US
Practice Address - Phone:817-539-0959
Practice Address - Fax:817-539-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty