Provider Demographics
NPI:1255407441
Name:MOUNTAIN VIEW DERMATOLOGY,P.A.
Entity type:Organization
Organization Name:MOUNTAIN VIEW DERMATOLOGY,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MT VIEW DERMATOLOGY, P.A
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-759-7700
Mailing Address - Street 1:3101 ZION LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3531
Mailing Address - Country:US
Mailing Address - Phone:915-759-7700
Mailing Address - Fax:915-759-7778
Practice Address - Street 1:8820 GATEWAY BLVD N
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1947
Practice Address - Country:US
Practice Address - Phone:915-759-7700
Practice Address - Fax:915-759-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00741VMedicare ID - Type Unspecified