Provider Demographics
NPI:1891765590
Name:BAY AREA DERMATOLOGY ASSOCIATES
Entity type:Organization
Organization Name:BAY AREA DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-332-8571
Mailing Address - Street 1:12 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4127
Mailing Address - Country:US
Mailing Address - Phone:281-332-8571
Mailing Address - Fax:281-332-8307
Practice Address - Street 1:12 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4127
Practice Address - Country:US
Practice Address - Phone:281-332-8571
Practice Address - Fax:281-332-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081DEOtherBCBS OF TEXAS
CK2746OtherMEDICARE RR
TX00816KMedicare PIN