Provider Demographics
NPI:1972906592
Name:TEXAS MOHS SURGERY AND SKIN CANCER CENTER, PLLC
Entity type:Organization
Organization Name:TEXAS MOHS SURGERY AND SKIN CANCER CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SAPORITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-396-5227
Mailing Address - Street 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1744
Mailing Address - Country:US
Mailing Address - Phone:214-396-5227
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1744
Practice Address - Country:US
Practice Address - Phone:214-396-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3726207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358056501Medicaid