Provider Demographics
NPI:1104973684
Name:BAYLOR HAIR CENTER PARTNERSHIP
Entity type:Organization
Organization Name:BAYLOR HAIR CENTER PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-820-4247
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1058 WADLEY TOWER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-820-4247
Mailing Address - Fax:214-821-3873
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 1058 WADLEY TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-820-4247
Practice Address - Fax:214-821-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2110207ZP0102X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JK29Medicare PIN
TX00QW69Medicare PIN