Provider Demographics
NPI:1689049413
Name:THE DERMATOLOGY SPOT PLLC
Entity Type:Organization
Organization Name:THE DERMATOLOGY SPOT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-609-4114
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-1345
Mailing Address - Country:US
Mailing Address - Phone:817-609-4114
Mailing Address - Fax:817-609-4116
Practice Address - Street 1:1841 MARTIN DR
Practice Address - Street 2:200
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-609-4114
Practice Address - Fax:817-609-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty