Provider Demographics
NPI:1295721066
Name:LUBBOCK DERMATOLOGY AND SKIN CANCER CENTER
Entity type:Organization
Organization Name:LUBBOCK DERMATOLOGY AND SKIN CANCER CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-796-7193
Mailing Address - Street 1:3601 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1309
Mailing Address - Country:US
Mailing Address - Phone:806-796-7193
Mailing Address - Fax:806-796-0034
Practice Address - Street 1:3601 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1309
Practice Address - Country:US
Practice Address - Phone:806-796-7193
Practice Address - Fax:806-796-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88220NMedicare PIN