Provider Demographics
NPI:1659132389
Name:SKYLINE DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:SKYLINE DERMATOLOGY PLLC
Other - Org Name:SKYLINE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:737-231-1855
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-1048
Mailing Address - Country:US
Mailing Address - Phone:737-231-1855
Mailing Address - Fax:737-221-5662
Practice Address - Street 1:120 CHRIS KELLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5359
Practice Address - Country:US
Practice Address - Phone:737-231-1855
Practice Address - Fax:737-221-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty