SOUTH TEXAS DERMATOLOGY,PLLC (NPI# 1356536494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356536494 |
| Entity Type | Organization |
| Organization Name | SOUTH TEXAS DERMATOLOGY,PLLC |
| Practice Address |
4141 S. Staples Suite 300 Corpus Christi TX 78411-2929 |
| Practice Telephone | 3618825560 |
| Practice Fax Number | 3618826011 |
| Mailing Telephone | 3618825560 |
| Mailing Fax Number | 3618826011 |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2017-05-16 |
| Authorized Official Name | MRS. JENNIFER LYNN VINCENT (OFFICE MANAGER) |
| Authorized Official Telephone | 3618825560 |
| Authorized Official Credential | CDC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
J4105 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BLUE CROSS BLUE SHIELD | 0040EE | 01 |
| TX | MEDICARE RAILROAD | CK7292 | 01 |
| TX | 080856001 | 05 |
| Street Address |
4141 S. STAPLES SUITE 300 |
| City | CORPUS CHRISTI |
| State | TX |
| Zip Code | 78411-2929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609871193 | Paul A Reinhart | Physician Assistant | 4141 S. Staples Suite 300, Corpus Christi, TX 78411-2929 | 2005-06-20 |
| 1841443231 | Nathan Andrew Davis | Dermatology | 4141 S. Staples Suite 300, Corpus Christi, TX 78411-2155 | 2008-10-29 |
| 1942206180 | Wayne A Fagan | Dermatology | 4141 S. Staples Suite 300, Corpus Christi, TX 78411-2929 | 2005-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487216032 | Robert W. Galbreath | Family Medicine | 3515 S Alameda St, Corpus Christi, TX 78411 | 2019-07-03 |
| 1669952313 | Maranda Deleon | Physical Therapy Assistant | 4406 Stonegate Way, Corpus Christi, TX 78411 | 2018-08-21 |
| 1730675257 | Cns Diagnostics Incorporated | Specialist/Technologist, Other | 5262 South Staples, Ste. 211, Corpus Christi, TX 78411 | 2018-07-09 |
| 1750828257 | Kerr Technical Services, LLC | Technician | 5262 S. Staples St., Suite 220, Corpus Christi, TX 78411 | 2017-01-23 |
| 1700337862 | Rebekah Welty | Audiologist | 3533 Alameda St, Corpus Christi, TX 78411 | 2016-10-24 |
| 1518330059 | Lilo Burda | Counselor | 321 Texan Trl Ste 220, Corpus Christi, TX 78411 | 2015-11-05 |
| 1730557182 | Amy Luu Q.a. Mai | Optometrist | 5488 S. Padre Island Drive, Suite 2042, Corpus Christi, TX 78411 | 2015-09-02 |
| 1487030417 | Luis Fuentes IIi | General Practice | 4818 Holly Rd Ste A, Corpus Christi, TX 78411 | 2015-07-31 |
| 1427430859 | Saguaro Anesthesia Associates, P.a. | Specialist | 4646 Corona Drive Suite #256, Corpus Christi, TX 78411 | 2015-06-22 |
| 1306224605 | Bonnie Lee Braglia Lpc-s,lmft,ccdvc | Community/Behavioral Health | 4659 Everhart Rd. Suite 109, Corpus Christi, TX 78411 | 2015-05-07 |
| Find all providers in zip 78411 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942206180 | Wayne A Fagan | Dermatology | 4141 S. Staples Suite 300, Corpus Christi, TX 78411-2929 | 2005-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649800848 | Skin Cancer Dermatology, Pllc | Dermatology | 3327 Research Plz Ste 414, San Antonio, TX 78235-5159 | 2020-01-16 |
| 1598302721 | Austin Skin Pllc | Dermatology | 1501 Dorothy Nichols Ln # B, Smithville, TX 78957-1725 | 2019-12-06 |
| 1154717726 | Joshua Lee Owen | Dermatology | 2632 Broadway, Suite 300 South, San Antonio, TX 78215-7821 | 2015-04-10 |
| 1043615263 | Epiphany Dermatology Pa | Dermatology | 7106 Sanger Avenue, Waco, TX 76712-3928 | 2014-10-30 |
| 1255745915 | Leon Chen | Dermatology | 6655 Travis St Ste 650, Houston, TX 77030-1316 | 2014-06-19 |
| 1750624391 | Houston Skin Cancer Associates, Pllc | Dermatology | 1401 Binz Street, Suite 200, Houston, TX 77004 | 2013-04-02 |
| 1457695413 | Oliver Street 5.01(a) Inc. | Dermatology | 5310 Harvest Hill Rd Ste 290, Dallas, TX 75230-5826 | 2012-11-15 |
| 1427330588 | Michael A. Sorace Md Pa | Dermatology | 7950 Floyd Curl Dr Ste 505, Medical Center Tower 1, San Antonio, TX 78229-3924 | 2011-09-15 |
| 1811229180 | Skin Surgery Center, Pa | Dermatology | 6208 Colleyville Blvd, Suite 100, Colleyville, TX 76034-6223 | 2010-02-11 |
| 1265614168 | Michael Sorace | Dermatology | 745 W San Antonio Ave, Suite 100, Boerne, TX 78006-3213 | 2007-12-03 |
| Find all providers with the same taxonomy | ||||
| City | CORPUS CHRISTI |
| Zip Code | 78411 |
Please comment or provide details below to improve the information on SOUTH TEXAS DERMATOLOGY,PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.