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LONE STAR STATE DERMATOLOGY CLINIC PLLC NPI 1053723239


NPI Information

NPI: 1053723239
Provider Name: LONE STAR STATE DERMATOLOGY CLINIC PLLC
Classification: Dermatology - 207NS0135X
Entity Type: Organization

Specialization: Procedural Dermatology

Address:
11485 TOEPPERWEIN RD
SUITE 2
LIVE OAK, TX
ZIP 78233
Phone: (210) 651-3233
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LONE STAR STATE DERMATOLOGY CLINIC PLLC is a procedural dermatology dermatology in Live Oak, TX. The provider is procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). LONE STAR STATE DERMATOLOGY CLINIC PLLC NPI is 1053723239. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

11485 TOEPPERWEIN RD
SUITE 2
LIVE OAK, TX
ZIP 78233-143
Phone: (210) 651-3233
Fax: (210) 651-3234

The provider's authorized official is Michelle Nicole Reyes .
The authorized official title is Office Manager and has the following contact phone number (210) 651-3233.

The enumeration date for this NPI number is 5/22/2014 and was last updated on 11/17/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207NS0135XDermatologyProcedural DermatologyK8022TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1H19937MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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