Provider Demographics
NPI:1730668567
Name:SIMONE STALLING MD PHD PLLC
Entity Type:Organization
Organization Name:SIMONE STALLING MD PHD PLLC
Other - Org Name:AVIVA DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:STALLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:713-468-0303
Mailing Address - Street 1:915 GESSNER RD STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2568
Mailing Address - Country:US
Mailing Address - Phone:713-468-0303
Mailing Address - Fax:
Practice Address - Street 1:915 GESSNER RD STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2568
Practice Address - Country:US
Practice Address - Phone:713-468-0303
Practice Address - Fax:713-468-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty