Provider Demographics
NPI:1396805750
Name:MOHS SKIN CANCER SURGERY OF SOUTH TEXAS PA
Entity type:Organization
Organization Name:MOHS SKIN CANCER SURGERY OF SOUTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:RHODES
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-8200
Mailing Address - Street 1:5282 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 518
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-615-8200
Mailing Address - Fax:210-615-8220
Practice Address - Street 1:5282 MEDICAL DRIVE
Practice Address - Street 2:SUITE 518
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-615-8200
Practice Address - Fax:210-615-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L73LMedicare PIN