Provider Type Icon

DERMATOLOGY AND LASER CENTER OF TYLER P.A. NPI 1568515047


NPI Information

NPI: 1568515047
Provider Name: DERMATOLOGY AND LASER CENTER OF TYLER, P.A.
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 45D2063115

Address:
700 OLYMPIC PLAZA CIR
SUITE 404
TYLER, TX
ZIP 75701
Phone: (903) 595-2737
Get Directions

DERMATOLOGY AND LASER CENTER OF TYLER, P.A. is a specialist in Tyler, TX. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DERMATOLOGY AND LASER CENTER OF TYLER, P.A. NPI is 1568515047. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

700 OLYMPIC PLAZA CIR
SUITE 404
TYLER, TX
ZIP 75701-951
Phone: (903) 595-2737
Fax: (903) 592-2732

The provider's authorized official is Ronald S Davis .
The authorized official title is Owner Physician and has the following contact phone number (903) 595-2737.

The CLIA number assigned to this NPI record is 45D2063115 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/19/2007 and was last updated on 8/22/2020.


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
1174400000XSpecialistG0686TEXASYes

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.