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CIBOLO CREEK DERMATOLOGY GROUP NPI 1083118111


NPI Information

NPI: 1083118111
Provider Name: CIBOLO CREEK DERMATOLOGY GROUP
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 45D1105792

Address:
120 DIETERT AVE BLDG STE 300
BOERNE, TX
ZIP 78006
Phone: (830) 971-9151
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CIBOLO CREEK DERMATOLOGY GROUP is a dermatology in Boerne, TX. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. CIBOLO CREEK DERMATOLOGY GROUP NPI is 1083118111. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

120 DIETERT AVE BLDG STE 300
BOERNE, TX
ZIP 78006-406
Phone: (830) 971-9151
Fax: (830) 331-2475

The provider's authorized official is Mary Adair .
The authorized official title is Billing and has the following contact phone number (830) 214-7960.

The CLIA number assigned to this NPI record is 45D1105792 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/22/2018 and was last updated on 8/24/2020.


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
1207N00000XDermatologyJ9523TEXASYes

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: 4/28/2024

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