Provider Demographics
NPI:1619387842
Name:ANNAM THE NINTH LP
Entity Type:Organization
Organization Name:ANNAM THE NINTH LP
Other - Org Name:MESQUITE MEDICAL AND COSMETIC DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TINH
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-529-1525
Mailing Address - Street 1:1324 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2440
Mailing Address - Country:US
Mailing Address - Phone:816-529-1525
Mailing Address - Fax:
Practice Address - Street 1:2704 N GALLOWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6379
Practice Address - Country:US
Practice Address - Phone:972-288-3376
Practice Address - Fax:972-288-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4546207N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty