Provider Demographics
NPI:1619099124
Name:OASIS DERMATOLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:OASIS DERMATOLOGY GROUP, PLLC
Other - Org Name:DERMATOLOGY CLINIC OF MCALLEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:JUI HAN
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-971-0404
Mailing Address - Street 1:3100 BUDDY OWENS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-971-0404
Mailing Address - Fax:956-971-0408
Practice Address - Street 1:3100 BUDDY OWENS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-971-0404
Practice Address - Fax:956-971-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4533207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179339001Medicaid
TX00W322Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX179339001Medicaid