Provider Demographics
NPI:1619919958
Name:THE WOODLANDS DERMATOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:THE WOODLANDS DERMATOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-363-5050
Mailing Address - Street 1:9303 PINECROFT DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3181
Mailing Address - Country:US
Mailing Address - Phone:281-363-5050
Mailing Address - Fax:281-363-5020
Practice Address - Street 1:9303 PINECROFT DR
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3181
Practice Address - Country:US
Practice Address - Phone:281-363-5050
Practice Address - Fax:281-363-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00226VOtherBLUE CROSS BLUE SHIELD
TX00226VMedicare ID - Type UnspecifiedMEDICARE GROUP ID