Organization
DERMATOLOGY & PLASTIC SURGERY ASSOCIATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT A.M. GARDERE M.D. (PRESIDENT)
(254) 752-2575
Entity
Organization
Contact information
Practice address
3115 PINE AVE, SUITE 908, WACO, TX 76708-3247
(254) 752-2575
(254) 752-0188
Mailing address
3115 PINE AVE, SUITE 908, WACO, TX 76708-3247
(254) 752-2575
(254) 752-0188
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E7938
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00CR41
BLUECROSS BLUESHIELD OF TEXAS
TX
05
—
1303794-02
—
TX
Enumeration date
01/09/2009
Last updated
01/09/2009
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