Provider Demographics
NPI:1609011154
Name:DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT
Entity Type:Organization
Organization Name:DANIEL J LADD JR DO PA DBA AUSTIN CENTER FOR SKIN HEALTH AND REJUVENAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LADD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:512-451-0139
Mailing Address - Street 1:3500 JEFFERSON ST
Mailing Address - Street 2:#200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6224
Mailing Address - Country:US
Mailing Address - Phone:512-451-0139
Mailing Address - Fax:512-323-5880
Practice Address - Street 1:2 SAINT MARKS PL
Practice Address - Street 2:#110
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1251
Practice Address - Country:US
Practice Address - Phone:512-451-0139
Practice Address - Fax:512-323-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00745WMedicare PIN
TXH29480Medicare UPIN