Organization Active NPI

Texas Dermatology Center PLLC

  • Dermatology Physician
  • Georgetown, TX
National Provider Identifier
1154633303
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M6125 Issued in TX
Legal business name
TEXAS DERMATOLOGY CENTER PLLC
Practice address
1900 Scenic Dr Ste 2208
Georgetown, TX 78626-7703
Phone
(512) 868-9800
Fax
(512) 868-9811
NPI assigned
Jul 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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

Authorized official

Name
Dr. Mary Evers, D.O.
Title
Owner
Phone
(440) 796-3231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X M6125 TX Primary

Addresses

Primary practice location

1900 Scenic Dr Ste 2208
Georgetown, TX 78626-7703

Mailing address

1900 Scenic Dr Ste 2208
Georgetown, TX 78626-7703
Phone (512) 868-9800

National Provider Directory

National Provider Directory

Locations

2118 Scenic Dr
Georgetown, TX 78626
Phone (512) 863-5678

3201 S Austin Ave
Ste 115
Georgetown, TX 78626
Phone (512) 763-4000

NPI Registry JSON

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

{
    "created_epoch": "1278201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563840000000",
    "number": "1154633303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SCENIC DR STE 2208",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786267703",
            "telephone_number": "512-868-9800",
            "fax_number": "512-868-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SCENIC DR STE 2208",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786267703",
            "telephone_number": "512-868-9800",
            "fax_number": "512-868-9811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS DERMATOLOGY CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-04",
        "last_updated": "2019-07-23",
        "status": "A",
        "authorized_official_last_name": "EVERS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-796-3231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M6125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; 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.