Provider Demographics
NPI:1942645387
Name:COMPASSION DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:COMPASSION DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBUYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-682-8846
Mailing Address - Street 1:2225 W SOUTHLAKE BLVD
Mailing Address - Street 2:STE 423-16
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6750
Mailing Address - Country:US
Mailing Address - Phone:817-380-5911
Mailing Address - Fax:
Practice Address - Street 1:3065 W SOUTHLAKE BLVD
Practice Address - Street 2:STE 140
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6730
Practice Address - Country:US
Practice Address - Phone:817-380-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0724207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003833658OtherNPI