Provider Demographics
NPI:1629714589
Name:DERMREPUBLIC PLLC
Entity Type:Organization
Organization Name:DERMREPUBLIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EREZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MINKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-920-2456
Mailing Address - Street 1:1885 FM 2673 STE H109
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-4765
Mailing Address - Country:US
Mailing Address - Phone:512-920-2456
Mailing Address - Fax:877-991-6353
Practice Address - Street 1:18830 FORTY SIX PKWY
Practice Address - Street 2:BLDG 4
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78707
Practice Address - Country:US
Practice Address - Phone:512-920-2456
Practice Address - Fax:877-991-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty