Provider Demographics
NPI:1831792449
Name:LONGHORN DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:LONGHORN DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RANSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-961-5250
Mailing Address - Street 1:4900 BEE CREEK RD # 101
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6776
Mailing Address - Country:US
Mailing Address - Phone:512-961-5250
Mailing Address - Fax:512-961-5014
Practice Address - Street 1:4900 BEE CREEK RD # 101
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6776
Practice Address - Country:US
Practice Address - Phone:512-961-5250
Practice Address - Fax:512-961-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty