Organization
PRESTIGE DERMATOLOGY OF MIDLOTHIAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PHAM (MANAGING MEMBER)
(817) 718-3571
Entity
Organization
Contact information
Practice address
320 HAWKINS RUN RD., SUITE 1, MIDLOTHIAN, TX 76065
(469) 758-4800
Mailing address
320 HAWKINS RUN RD, SUITE 1, MIDLOTHIAN, TX 76065
(469) 758-4800
(972) 775-4567
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
10/11/2019
Last updated
07/31/2020
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