Organization
MOUNTAIN WEST DERM - BLACKHART PLLC
Active
Organization
MOUNTAIN WEST DERM - BLACKHART PLLC
Active
Other names
Vitalogy Skincare
Organization subpart
No
Provider details
NPI number
Authorized official
BRET S BLACKHART MD (PRESIDENT)
(775) 336-3624
Entity
Organization
Contact information
Practice address
4513 WILLIAMS DR, GEORGETOWN, TX 78633-1302
(512) 930-3909
(512) 240-5469
Mailing address
4513 WILLIAMS DR, GEORGETOWN, TX 78633-1302
(512) 763-3803
(512) 240-5469
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
Other
Enumeration date
06/03/2021
Last updated
06/14/2021
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