Provider Demographics
NPI:1194060343
Name:METROPOLITAN DERMATOLOGY INSTITUTE PLLC
Entity type:Organization
Organization Name:METROPOLITAN DERMATOLOGY INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-955-1333
Mailing Address - Street 1:4055 WESTHEIMER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5015
Mailing Address - Country:US
Mailing Address - Phone:713-955-1333
Mailing Address - Fax:713-955-1331
Practice Address - Street 1:4055 WESTHEIMER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5015
Practice Address - Country:US
Practice Address - Phone:713-955-1333
Practice Address - Fax:713-955-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L7840Medicare UPIN