Organization
LONE STAR STATE DERMATOLOGY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRA PEACOCK (OFFICE MANAGER)
(210) 651-3233
Entity
Organization
Contact information
Practice address
11101 TOEPPERWEIN RD, LIVE OAK, TX 78233-3048
(210) 651-3233
(210) 651-3234
Mailing address
11101 TOEPPERWEIN RD, LIVE OAK, TX 78233-3048
(210) 651-3233
(210) 651-3234
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
K8022
TX
Other
Enumeration date
05/22/2014
Last updated
12/20/2023
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