Provider Demographics
NPI:1962838524
Name:FRESH DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:FRESH DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:THRASH NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-615-5600
Mailing Address - Street 1:1008 RR 620 S STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5632
Mailing Address - Country:US
Mailing Address - Phone:512-615-5600
Mailing Address - Fax:512-615-5606
Practice Address - Street 1:1008 RR 620 S STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5632
Practice Address - Country:US
Practice Address - Phone:512-615-5600
Practice Address - Fax:512-615-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty