Dermatology & Plastic Surgery Association, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

E7938 Issued in TX

Legal business name

DERMATOLOGY & PLASTIC SURGERY ASSOCIATION, INC.

Practice address

3115 Pine Ave
Suite 908
Waco, TX 76708-3247

Phone

(254) 752-2575

Fax

(254) 752-0188

NPI assigned

Jan 9, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert A.M. Gardere, M.D.

Title

President

Phone

(254) 752-2575

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231459200000",
    "number": "1023255254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3115 PINE AVE",
            "address_2": "SUITE 908",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083247",
            "telephone_number": "254-752-2575",
            "fax_number": "254-752-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 PINE AVE",
            "address_2": "SUITE 908",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083247",
            "telephone_number": "254-752-2575",
            "fax_number": "254-752-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & PLASTIC SURGERY ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-09",
        "last_updated": "2009-01-09",
        "status": "A",
        "authorized_official_last_name": "GARDERE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A.M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "254-752-2575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "E7938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303794-02",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD OF TEXAS",
            "identifier": "00CR41",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Angela Jean Devinney, LPC
• Marisela Devora

• Specialist in Waco, TX
• Providers in Waco, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.