Organization
VITALOGY P.A.
Active
Organization
VITALOGY P.A.
Active
Other names
Vitalogy Skincare
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RAMM (CFO)
(512) 930-3909
Entity
Organization
Contact information
Practice address
4513 WILLIAMS DR, GEORGETOWN, TX 78633-1302
(512) 930-3909
(512) 240-5469
Mailing address
4513 WILLIAMS DR, GEORGETOWN, TX 78633-1302
(512) 930-3909
(512) 240-5469
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M5607
TX
207ND0101X
MOHS-Micrographic Surgery Physician
M5607
TX
Other
Enumeration date
06/28/2007
Last updated
02/06/2017
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