Provider Demographics
NPI:1760721278
Name:HOUSTON INSTITUTE OF DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:HOUSTON INSTITUTE OF DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BERTHELOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-480-7272
Mailing Address - Street 1:PO BOX 273144
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277-3144
Mailing Address - Country:US
Mailing Address - Phone:281-480-7272
Mailing Address - Fax:281-480-7273
Practice Address - Street 1:2565 BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1521
Practice Address - Country:US
Practice Address - Phone:281-480-7272
Practice Address - Fax:281-480-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7042207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty