PRESTIGE DERMATOLOGY OF ALLIANCE, PLLC (NPI# 1427415314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427415314 |
| Entity Type | Organization |
| Organization Name | PRESTIGE DERMATOLOGY OF ALLIANCE, PLLC |
| Practice Address |
3629 Western Center Blvd Suite 201 Fort Worth TX 76137-1939 |
| Mailing Address |
3629 Western Center Blvd Ste 211 Fort Worth TX 76137-1940 |
| Practice Telephone | 8177667421 |
| Mailing Telephone | 8177667422 |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2020-07-28 |
| Authorized Official Name | RYAN PHAM (MANAGING MEMBER) |
| Authorized Official Telephone | 8177183571 |
| Authorized Official Credential | D.O |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Street Address |
3629 WESTERN CENTER BLVD SUITE 201 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76137-1939 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376512152 | Brent Gordon | Family Medicine | 3629 Western Center Blvd, Ste. 211, Fort Worth, TX 76137-1939 | 2006-03-15 |
| 1144649088 | Ketki Manohar Rana | Physical Therapist | 3629 Western Center Blvd, Ste.221, Fort Worth, TX 76137-1939 | 2014-04-08 |
| 1336420918 | Christina Catherine Jones | Counselor | 3629 Western Center Blvd, Fort Worth, TX 76137-1939 | 2011-09-08 |
| 1215164835 | Jason M Mccoy | Social Worker | 3629 Western Center Blvd, Ste. 211, Fort Worth, TX 76137-1939 | 2009-06-22 |
| 1710133897 | Craig Freyer, M.d. | General Practice | 3629 Western Center Blvd, Suite 201, Fort Worth, TX 76137-1939 | 2008-08-08 |
| 1720097801 | Craig Alan Freyer | Family Medicine | 3629 Western Center Blvd, 201, Fort Worth, TX 76137-1939 | 2006-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962975581 | Rose Kabera | Registered Nurse | 8021 Jolie Dr, Fort Worth, TX 76137 | 2019-01-07 |
| 1043786569 | Grace-marie Jones | Licensed Vocational Nurse | 5201 Endicott Avenue, Fort Worth, TX 76137 | 2018-10-23 |
| 1104327683 | Jeris Taylor | Registered Nurse | 4144 Heritage Way Dr, Fort Worth, TX 76137 | 2018-02-21 |
| 1396269429 | Matthew Pedroza | Dentist | 4625 Feathercrest Dr., Fort Worth, TX 76137 | 2017-07-31 |
| 1447789896 | Texas Surgical Ally | Physician Assistant | 6677 Friendsway Dr, Fort Worth, TX 76137 | 2017-06-08 |
| 1992249239 | Tracy Kirk Dds, Pllc | Dentist | 6300 N. Beach St, Ft Worth, TX 76137 | 2016-12-06 |
| 1992103295 | Keller Modern Dentistry and Orthodontics, PC | Dentist | 5701 N. Tarrant Pkwy, Suite 101, Fort Worth, TX 76137 | 2014-12-18 |
| 1619380805 | Ikids Pediatric Dentistry and Orthodontics Nfw | Dentist | 7451 N Beach St, Ste 140, Fort Worth, TX 76137 | 2014-06-05 |
| 1205246758 | Jack Milton Curlee Jr. | Counselor | 3629 Western Center Blvd., Suite 211, Fort Worth, TX 76137 | 2014-05-06 |
| 1932457363 | Milestone Dental of Keller, Pllc | Dentist | 5800 North Tarrant Parkway, Suite 102, Fort Worth, TX 76137 | 2012-08-15 |
| Find all providers in zip 76137 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417434119 | Dermatology Specialists of Fort Worth Pllc | Dermatology | 6100 Southwest Blvd., Suite 100, Fort Worth, TX 76109 | 2018-07-25 |
| 1447702964 | West Fort Worth Dermatology, P.a. | Dermatology | 4840 Bryant Irvin Ct, Suite 104, Fort Worth, TX 76107-7679 | 2016-11-01 |
| 1306228432 | Molly M Warthan Md | Dermatology | 1622 8th Ave Ste 120, Fort Worth, TX 76104-4155 | 2015-06-25 |
| 1407260151 | Heather Reagin | Dermatology | 2421 W 7th St Ste 205, Fort Worth, TX 76107-2393 | 2014-06-19 |
| 1548581564 | Julie Nguyen | Dermatology | 3516 Golden Triangle Blvd Ste 120, Fort Worth, TX 76244 | 2010-06-14 |
| 1407176043 | Northstar Dermatology, Pa | Dermatology | 5320 N Tarrant Pkwy, Suite 200, Fort Worth, TX 76244-5387 | 2010-06-06 |
| 1073773867 | Molly Mae Warthan | Dermatology | 5751 Edwards Ranch Rd Ste 101, Fort Worth, TX 76109-4131 | 2008-06-15 |
| 1558569087 | Ronald Todd Plott | Dermatology | 12469 Timberland Blvd, Ste 501, Fort Worth, TX 76244-6548 | 2007-07-05 |
| 1427253095 | Jennifer Kathleen Tan | Dermatology | 5320 N Tarrant Pkwy Ste 200, Fort Worth, TX 76244-5387 | 2007-06-15 |
| 1942428024 | Faith Ashley Stewart | Dermatology | 7000 Bryant Irvin Rd, Ste 100, Fort Worth, TX 76132-4251 | 2007-04-23 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76137 |
Please comment or provide details below to improve the information on PRESTIGE DERMATOLOGY OF ALLIANCE, 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.