Organization
PRISM DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER GAMAN MD (PRESIDENT)
(972) 258-7499
Entity
Organization
Contact information
Practice address
925 E SOUTHLAKE BLVD STE 200, SOUTHLAKE, TX 76092-1476
(940) 393-9582
Mailing address
925 E SOUTHLAKE BLVD STE 200, SOUTHLAKE, TX 76092-1476
(940) 393-9582
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
09/27/2018
Last updated
09/27/2018
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