Organization
WESTLAKE DERMATOLOGY PA
Active
Other names
Westlake Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY A NIKOLAIDIS M.D. (PRESIDENT)
(512) 328-3376
Entity
Organization
Contact information
Practice address
507 W FM 2147, SUITE 202, MARBLE FALLS, TX 78654-6279
(512) 328-3376
(512) 306-0222
Mailing address
8825 BEE CAVE RD, SUITE 100, AUSTIN, TX 78746-4720
(512) 328-3376
(512) 306-0222
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
TX
363A00000X
Physician Assistant
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00591T
BCBS OF TEXAS GROUP#
TX
Enumeration date
05/13/2008
Last updated
11/05/2015
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