Provider Demographics
NPI:1851720056
Name:PREMIER DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:PREMIER DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-677-7546
Mailing Address - Street 1:1525 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2906
Mailing Address - Country:US
Mailing Address - Phone:325-677-7546
Mailing Address - Fax:325-676-7546
Practice Address - Street 1:1525 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2906
Practice Address - Country:US
Practice Address - Phone:325-677-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty