Provider Demographics
NPI:1679064968
Name:HUMBLE DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:HUMBLE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-707-6400
Mailing Address - Street 1:18980 NORTH MEMORIAL DRIVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:281-707-6400
Mailing Address - Fax:
Practice Address - Street 1:18980 NORTH MEMORIAL DRIVE
Practice Address - Street 2:STE. 200
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-707-6400
Practice Address - Fax:281-584-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty