Provider Demographics
NPI:1134447949
Name:ADVANCED ASSOCIATES IN DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:ADVANCED ASSOCIATES IN DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:SOARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-385-8189
Mailing Address - Street 1:440 RAYFORD RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1918
Mailing Address - Country:US
Mailing Address - Phone:281-385-8189
Mailing Address - Fax:281-203-5037
Practice Address - Street 1:440 RAYFORD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1918
Practice Address - Country:US
Practice Address - Phone:281-385-8189
Practice Address - Fax:281-203-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9017207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty