Organization
BRAZOSPORT DERMATOLOGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK A PELTIER MD (PRESIDENT)
(979) 297-6458
Entity
Organization
Contact information
Practice address
BRAZOSPORT DERMATOLOGY CLINIC PA, 215 OAK DRIVE SOUTH STE C, LAKE JACKSON, TX 77566
(979) 297-6458
(979) 297-0076
Mailing address
215 OAK DR S, STE C, LAKE JACKSON, TX 77566-5617
(979) 297-6458
(979) 297-0076
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
F1894
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035781601
—
TX
Enumeration date
08/18/2006
Last updated
12/30/2010
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