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Organization

WESTLAKE DERMATOLOGY PA

Active
Other names
Westlake Dermatology
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GREGORY NIKOLAIDIS MD (PRESIDENT)
(512) 328-3376
Entity
Organization

Contact information

Practice address
1760 ROUND ROCK AVE, ROUND ROCK, TX 78681-4217
(512) 583-3376
(512) 306-0222
Mailing address
8825 BEE CAVE RD, SUITE 100, AUSTIN, TX 78746-4719
(512) 328-3376
(512) 306-0222

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
TX
207ND0900X
Dermatopathology Physician
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00591T
BCBS OF TEXAS GROUP#
TX
05
211724401
TX
Enumeration date
03/21/2007
Last updated
11/05/2015
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