Organization
SOUTHWEST SKIN & CANCER CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN DOUGLAS HOUSTON M.D. (OWNER)
(512) 444-7208
Entity
Organization
Contact information
Practice address
4419 FRONTIER TRL, SUITE 110, AUSTIN, TX 78745-1686
(512) 444-7208
(512) 444-2343
Mailing address
4419 FRONTIER TRL, SUITE 110, AUSTIN, TX 78745-1686
(512) 444-7208
(512) 444-2343
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084309601
—
TX
01
—
CG4257
MEDICARE RAILROAD
TX
Enumeration date
02/20/2006
Last updated
07/12/2011
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