Organization
WESTLAKE DERMATOLOGY PA
Active
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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