Organization
AFFILLIATED DERMATOLOGISTS OF CORPUS CHRISTI P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD L. IDEN M.D. (PRESIDENT)
(361) 993-9363
Entity
Organization
Contact information
Practice address
4521 S STAPLES ST STE 100, CORPUS CHRISTI, TX 78411-2603
(361) 993-9363
(361) 993-9366
Mailing address
4521 S STAPLES ST STE 100, CORPUS CHRISTI, TX 78411-2603
(361) 993-9363
(361) 993-9366
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BS#K40V
BLUE SHIELD
TX
Enumeration date
03/14/2007
Last updated
08/22/2020
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