South Texas Dermatology PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

J4105 Issued in TX

Legal business name

SOUTH TEXAS DERMATOLOGY PLLC

Practice address

1300 Third Street
Corpus Christi, TX 78404

Phone

(361) 882-5560

Fax

(361) 882-6011

NPI assigned

Dec 21, 2011

Last updated

Dec 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jennifer Lynn Vincent, CDC

Title

Business Manager

Phone

(361) 882-2338

Specialties & licenses 1

Addresses

Other names 1

• WAYNE A FAGAN MD Other name

Locations

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

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324425600000",
    "number": "1285903179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 THIRD STREET",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "78404",
            "telephone_number": "361-882-5560",
            "fax_number": "361-882-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 THIRD STREET",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "78404",
            "telephone_number": "361-882-5560",
            "fax_number": "361-882-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TEXAS DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-21",
        "last_updated": "2011-12-21",
        "status": "A",
        "authorized_official_last_name": "VINCENT",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "361-882-2338",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CDC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "J4105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAYNE A FAGAN MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• South Texas Brain & Spine Institute, P.a.
• South Texas Cleft Palate and Craniofacial Anomalies Team
• South Texas Clinical Laboratory LTD
• South Texas Comprehensive Cancer Centers PLLC
• South Texas Cpap
• South Texas Dermatology PLLC (South Texas Dermatology)
• South Texas Emergency Physicians, PLLP
• South Texas Endocrinology & Metabolism Center, PLLC
• South Texas Eye Consultants (Eye Care Optical)
• South Texas Eye Consultants (Eye Care Optical)

• Specialist in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; 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.