Provider Demographics
NPI:1124710363
Name:BLUE STAR DERMATOLOGY & AESTHETICS MANAGEMENT LLC
Entity type:Organization
Organization Name:BLUE STAR DERMATOLOGY & AESTHETICS MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MCSWIGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:972-497-4153
Mailing Address - Street 1:1 COWBOYS WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1977
Mailing Address - Country:US
Mailing Address - Phone:972-497-4153
Mailing Address - Fax:
Practice Address - Street 1:3800 GAYLORD PKWY STE 1080
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9416
Practice Address - Country:US
Practice Address - Phone:972-497-4153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty