Provider Demographics
NPI:1467826131
Name:MEDICA SKIN DIAGNOSTICS PLLC
Entity type:Organization
Organization Name:MEDICA SKIN DIAGNOSTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-443-7504
Mailing Address - Street 1:126 COLLEGE ST S
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2316
Mailing Address - Country:US
Mailing Address - Phone:936-443-7504
Mailing Address - Fax:
Practice Address - Street 1:2046 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5709
Practice Address - Country:US
Practice Address - Phone:936-443-7504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8136207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty