Organization
WESTLAKE DERMATOLOGY PA
Active
Other names
Westlake Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY A NIKOLAIDIS MD (PRESIDENT)
(512) 328-3376
Entity
Organization
Contact information
Practice address
12201 RENFERT WAY, SUITE 305, AUSTIN, TX 78758-5354
(512) 279-3376
(512) 306-0222
Mailing address
6836 BEE CAVE RD, SUITE 111, AUSTIN, TX 78746-5059
(512) 279-3376
(512) 306-0222
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00591T
BCBS GRP#
TX
Enumeration date
03/06/2007
Last updated
05/22/2008
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