Provider Demographics
NPI:1922244771
Name:SKIN SPECIALISTS, PA
Entity Type:Organization
Organization Name:SKIN SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:REDDICK
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-649-6644
Mailing Address - Street 1:1101 RAINTREE CIR
Mailing Address - Street 2:250
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4922
Mailing Address - Country:US
Mailing Address - Phone:972-649-6644
Mailing Address - Fax:972-649-6663
Practice Address - Street 1:1101 RAINTREE CIR
Practice Address - Street 2:250
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4922
Practice Address - Country:US
Practice Address - Phone:972-649-6644
Practice Address - Fax:972-649-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2021-03-01
Deactivation Date:2020-10-12
Deactivation Code:
Reactivation Date:2020-11-24
Provider Licenses
StateLicense IDTaxonomies
TXN1109207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty