Organization
BASIN DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE WYNNE (CREDENTIALING MANAGER)
(432) 686-6605
Entity
Organization
Contact information
Practice address
4214 ANDREWS HWY STE 110, MIDLAND, TX 79703-4864
(432) 689-2491
(432) 991-1158
Mailing address
4214 ANDREWS HWY STE 240, MIDLAND, TX 79703-4817
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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