Organization
SOUTH TEXAS DERMATOPATHOLOGY LAB PA
Active
Organization
SOUTH TEXAS DERMATOPATHOLOGY LAB PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS L DAVIS MD (LABORATORY DIRECTOR)
(210) 342-6488
Entity
Organization
Contact information
Practice address
1122 AUSTIN HWY, SAN ANTONIO, TX 78209-4844
(210) 342-6488
(210) 342-6725
Mailing address
1122 AUSTIN HWY, SAN ANTONIO, TX 78209-4844
(210) 342-6488
(210) 342-6725
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
G4960
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0421345
—
MT
05
—
100245340A
—
KS
05
—
110795501
—
TX
05
—
116882
—
MN
05
—
13211
—
ND
01
—
690004679
MEDICARE RR
TX
01
—
90013183
PACIFICALE
TX
05
—
912055600
—
FL
Enumeration date
07/19/2005
Last updated
07/12/2012
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