Organization
LADERA PARK DERMATOLOGY PA
Active
Organization
LADERA PARK DERMATOLOGY PA
Active
Other names
Lake Travis Dermatology PA
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE M FEASEL MD (PRESIDENT)
(512) 345-3599
Entity
Organization
Contact information
Practice address
11671 JOLLYVILLE RD STE 104, AUSTIN, TX 78759-4141
(512) 345-3599
(512) 345-3928
Mailing address
11671 JOLLYVILLE RD STE 104, AUSTIN, TX 78759-4141
(512) 345-3599
(512) 345-3928
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
L2883
TX
Other
Enumeration date
06/08/2017
Last updated
07/21/2022
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