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Organization

ABILENE DERMATOLOGY AND SKIN SURGERY CENTER PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SINA ABOUTALEBI MD (VICE PRESIDENT)
(325) 672-5603
Entity
Organization

Contact information

Practice address
3190 ANTILLEY RD, ABILENE, TX 79606-5006
(325) 672-5603
(325) 672-6570
Mailing address
3190 ANTILLEY ROAD, ABILENE, TX 79606-5015
(325) 672-5603
(325) 672-6570

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0087QH
BLUE CROSS BLUE SHIELD OF TEXAS
TX
01
CG5724
RAILROAD MEDICARE
TX
Enumeration date
11/02/2007
Last updated
11/15/2023
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