Provider Demographics
NPI:1124255377
Name:TEXAS DERMATOLOGY SPECIALISTS, PLLC
Entity type:Organization
Organization Name:TEXAS DERMATOLOGY SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FAYEZ
Authorized Official - Last Name:SEDRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-771-1100
Mailing Address - Street 1:929 GESSNER RD
Mailing Address - Street 2:SUITE 2205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2664
Mailing Address - Country:US
Mailing Address - Phone:713-771-1100
Mailing Address - Fax:713-771-1545
Practice Address - Street 1:929 GESSNER RD
Practice Address - Street 2:SUITE 2205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2664
Practice Address - Country:US
Practice Address - Phone:713-771-1100
Practice Address - Fax:713-771-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0078SQOtherBCBS
TX0078SQOtherBCBS