Organization
MODERN DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRINA WEST (OFFICE MANAGER)
(409) 835-4790
Entity
Organization
Contact information
Practice address
3485 FANNIN ST, BEAUMONT, TX 77701-3807
(409) 835-4790
(409) 835-2496
Mailing address
3485 FANNIN ST, BEAUMONT, TX 77701-3807
(409) 835-4790
(409) 835-2496
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
J3153
TX
Other
Enumeration date
10/12/2016
Last updated
10/12/2016
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