Organization
WESTLAKE DERMATOLOGY PA
Active
Other names
Westlake Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY A NIKOLAIDIS MD (PRESIDENT)
(512) 328-3376
Entity
Organization
Contact information
Practice address
8825 BEE CAVE RD, SUITE 100, AUSTIN, TX 78746-4719
(512) 328-3376
(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
207K00000X
Allergy & Immunology Physician
—
TX
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
TX
207ND0900X
Dermatopathology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00591T
BCBS GRP #
TX
Enumeration date
02/06/2006
Last updated
04/04/2017
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