Provider Demographics
NPI:1124783139
Name:MISMO SKIN AND WOUND INSTITUTE TX
Entity type:Organization
Organization Name:MISMO SKIN AND WOUND INSTITUTE TX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:
Authorized Official - Last Name:FERAMISCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:214-621-4303
Mailing Address - Street 1:835 E LAMAR BLVD STE 346
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3504
Mailing Address - Country:US
Mailing Address - Phone:214-621-4303
Mailing Address - Fax:
Practice Address - Street 1:1303 AUTUMN MIST WAY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-4533
Practice Address - Country:US
Practice Address - Phone:214-621-4303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty