Provider Demographics
NPI:1457778474
Name:UNITED DERMATOLOGY ASSOCIATES OF BURLESON, PLLC
Entity Type:Organization
Organization Name:UNITED DERMATOLOGY ASSOCIATES OF BURLESON, PLLC
Other - Org Name:JEANNINE HOANG, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-261-1122
Mailing Address - Street 1:2800 E BROAD ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6410
Mailing Address - Country:US
Mailing Address - Phone:817-261-1122
Mailing Address - Fax:817-261-1123
Practice Address - Street 1:780 NE ALSBURY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2641
Practice Address - Country:US
Practice Address - Phone:817-261-1122
Practice Address - Fax:817-261-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1144207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty