Provider Demographics
NPI:1962599217
Name:BAYTOWN DERMATOLOGY, P.A.
Entity type:Organization
Organization Name:BAYTOWN DERMATOLOGY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONNER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-425-9375
Mailing Address - Street 1:3730 EMMETT HUTTO BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-1764
Mailing Address - Country:US
Mailing Address - Phone:281-425-9375
Mailing Address - Fax:281-427-4584
Practice Address - Street 1:3730 EMMETT HUTTO BLVD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-1764
Practice Address - Country:US
Practice Address - Phone:281-425-9375
Practice Address - Fax:281-427-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0496518CLIA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX690008222OtherRAILROAD MEDICARE
TXCL8288OtherBLUE CROSS BLUE SHIELD TX
TX45D0496518OtherCLIA
TX690008222OtherRAILROAD MEDICARE