Provider Demographics
NPI:1154435840
Name:GALVESTON DERMATOLOGY, P.A.
Entity type:Organization
Organization Name:GALVESTON DERMATOLOGY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-763-6534
Mailing Address - Street 1:1501 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-4906
Mailing Address - Country:US
Mailing Address - Phone:409-763-6534
Mailing Address - Fax:409-763-2458
Practice Address - Street 1:1501 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-4906
Practice Address - Country:US
Practice Address - Phone:409-763-6534
Practice Address - Fax:409-763-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0950289291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00413770OtherRAILROAD MEDICARE
TXP00413770OtherRAILROAD MEDICARE