Organization
SOUTH TEXAS DERMATOLOGY PLLC
Active
Other names
WAYNE A FAGAN MD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JENNIFER LYNN VINCENT CDC (BUSINESS MANAGER)
(361) 882-2338
Entity
Organization
Contact information
Practice address
1300 THIRD STREET, CORPUS CHRISTI, TX 78404
(361) 882-5560
(361) 882-6011
Mailing address
1300 THIRD STREET, CORPUS CHRISTI, TX 78404
(361) 882-5560
(361) 882-6011
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J4105
TX
Other
Enumeration date
12/21/2011
Last updated
12/21/2011
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