45D2172119 CLIA NUMBER - PREMIER PROCEDURAL DERMATOLOGY PLLC

Laboratory Demographics

  • CLIA Code: 45D2172119
  • Facility Name: PREMIER PROCEDURAL DERMATOLOGY PLLC
  • Facility Address: 1651 ROCK PRAIRIE RD, SUITE 103
    COLLEGE STATION, TX
    ZIP 77845
  • Facility Phone: 979 314-5400
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: RYAN W. AHERN
  • NPI Number: 1053969287
  • Taxonomy: 207ND0101X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 45D2172119
LAB Type Physician Office
Facility Name PREMIER PROCEDURAL DERMATOLOGY PLLC
Street 1651 ROCK PRAIRIE RD, SUITE 103
City COLLEGE STATION
State TX
ZIP 77845
Phone 979 314-5400
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Physician Office
Lab Director RYAN W. AHERN

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