Provider Demographics
NPI:1659313427
Name:SOUTHWEST DERMATOPATHOLOGY CONSULTANTS, PA
Entity Type:Organization
Organization Name:SOUTHWEST DERMATOPATHOLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND DERMATOPATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-483-2100
Mailing Address - Street 1:2840 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4829
Mailing Address - Country:US
Mailing Address - Phone:214-483-2100
Mailing Address - Fax:214-483-2104
Practice Address - Street 1:2840 KELLER SPRINGS RD
Practice Address - Street 2:SUITE 1104
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-4829
Practice Address - Country:US
Practice Address - Phone:214-483-2100
Practice Address - Fax:214-483-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N28TMedicare UPIN