Provider Demographics
NPI:1245468917
Name:DERMATOLOGY & SKIN SURGERY INSTITUTE OF NORTH TEXAS, P.A.
Entity type:Organization
Organization Name:DERMATOLOGY & SKIN SURGERY INSTITUTE OF NORTH TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-712-5100
Mailing Address - Street 1:3535 VICTORY GROUP WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6721
Mailing Address - Country:US
Mailing Address - Phone:972-712-5100
Mailing Address - Fax:972-712-5113
Practice Address - Street 1:3535 VICTORY GROUP WAY STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6721
Practice Address - Country:US
Practice Address - Phone:972-712-5100
Practice Address - Fax:972-712-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062SQOtherBCBSTX ID NUMBER
TX0062SQOtherBCBSTX ID NUMBER