Provider Demographics
NPI:1619942182
Name:SOUTHWEST SKIN & CANCER CLINIC, P.A.
Entity Type:Organization
Organization Name:SOUTHWEST SKIN & CANCER CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-444-7208
Mailing Address - Street 1:4419 FRONTIER TRL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1686
Mailing Address - Country:US
Mailing Address - Phone:512-444-7208
Mailing Address - Fax:512-444-2343
Practice Address - Street 1:4419 FRONTIER TRL
Practice Address - Street 2:SUITE 110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1686
Practice Address - Country:US
Practice Address - Phone:512-444-7208
Practice Address - Fax:512-444-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCG4257OtherMEDICARE RAILROAD
TX084309601Medicaid
TXCG4257OtherMEDICARE RAILROAD