Provider Demographics
NPI:1013320258
Name:DOWNTOWN DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:DOWNTOWN DERMATOLOGY PLLC
Other - Org Name:CASTLE HILLS DERMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:SHAFFER
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-901-9353
Mailing Address - Street 1:PO BOX 17348
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-0348
Mailing Address - Country:US
Mailing Address - Phone:210-901-9353
Mailing Address - Fax:210-227-4297
Practice Address - Street 1:4118 MCCULLOUGH AVE STE 18
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1905
Practice Address - Country:US
Practice Address - Phone:210-901-9353
Practice Address - Fax:210-227-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8331207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339660801Medicaid
TX339660801Medicaid