Organization
LADERA PARK DERMATOLOGY, P.A.
Active
Organization
LADERA PARK DERMATOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET C DUBOIS 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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001MU
BLUE CROSS GROUP NUMBER
TX
Enumeration date
12/18/2006
Last updated
02/27/2013
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