Organization
TETON DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GHEORGHE PUSTA (EXECUTIVE DIRECTOR)
(512) 628-0465
Entity
Organization
Contact information
Practice address
984 WEST BROADWAY, SUITE 4, JACKSON, WY 83001-0000
(307) 734-1800
(307) 734-5012
Mailing address
7300 RANCH RD. 2222, BLDG 1, STE 200, AUSTIN, TX 78730
(512) 628-0465
(512) 628-0468
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
05/21/2010
Last updated
09/18/2024
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