Provider Demographics
NPI:1396074134
Name:THE WOODLANDS SKIN SURGERY CENTER PA
Entity type:Organization
Organization Name:THE WOODLANDS SKIN SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-364-8844
Mailing Address - Street 1:3786 FM 1488 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4989
Mailing Address - Country:US
Mailing Address - Phone:281-364-8844
Mailing Address - Fax:281-364-8833
Practice Address - Street 1:13325 HARGRAVE RD STE 130&140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4539
Practice Address - Country:US
Practice Address - Phone:281-364-8844
Practice Address - Fax:281-364-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty