Organization
BAYTOWN DERMATOLOGY, P.A.
Active
Other names
Baytown Dermatopathology Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
CONNER CHAN MD (CEO)
(281) 425-9375
Entity
Organization
Contact information
Practice address
3730 EMMETT HUTTO BLVD, BAYTOWN, TX 77521-1764
(281) 425-9375
(281) 427-4584
Mailing address
3730 EMMETT HUTTO BLVD, BAYTOWN, TX 77521-1764
(281) 425-9375
(281) 427-4584
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D0496518CLIA
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D0496518
CLIA
TX
01
—
690008222
RAILROAD MEDICARE
TX
01
—
CL8288
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
10/06/2006
Last updated
05/12/2020
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