45D1105005 CLIA NUMBER - BAYSIDE DERMATOLOGY, PA

Laboratory Demographics

  • CLIA Code: 45D1105005
  • Facility Name: BAYSIDE DERMATOLOGY, PA
  • Facility Address: 1321 WATERS EDGE DRIVE, SUITE 1006
    GRANBURY, TX
    ZIP 76048
  • Facility Phone: 817 573-1800
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DONALD J. BROWN, DO
  • NPI Number: 1215160312
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 45D1105005
LAB Type Physician Office
Facility Name BAYSIDE DERMATOLOGY, PA
Street 1321 WATERS EDGE DRIVE, SUITE 1006
City GRANBURY
State TX
ZIP 76048
Phone 817 573-1800
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/15/2025
Certificate Expiration Date 9/14/2027
Facility Type Physician Office
Lab Director DONALD J. BROWN, DO

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This page was last updated on: 9/29/2025