Organization
PRESTIGE DERMATOLOGY OF ALLIANCE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PHAM D.O (MANAGING MEMBER)
(817) 766-7421
Entity
Organization
Contact information
Practice address
3629 WESTERN CENTER BLVD, SUITE 201, FORT WORTH, TX 76137-1939
(817) 766-7421
Mailing address
3629 WESTERN CENTER BLVD STE 211, FORT WORTH, TX 76137-1940
(817) 766-7422
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
Other
Enumeration date
01/22/2016
Last updated
01/21/2021
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