Modern Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

J3153 Issued in TX

Legal business name

MODERN DERMATOLOGY PLLC

Practice address

3485 Fannin St
Beaumont, TX 77701-3807

Phone

(409) 835-4790

Fax

(409) 835-2496

NPI assigned

Oct 12, 2016

Organization subpart

No

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

Authorized official

Name

Trina West

Title

Office Manager

Phone

(409) 835-4790

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1356891576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 FANNIN ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777013807",
            "telephone_number": "409-835-4790",
            "fax_number": "409-835-2496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3485 FANNIN ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777013807",
            "telephone_number": "409-835-4790",
            "fax_number": "409-835-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "TRINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "409-835-4790"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "J3153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Mingo
• Charles Mitchell, RPH
• Lylieth Mitchell, M.D.
• Mobility Scooters
• Moc Beaumont, LLC
• Modest Care Services LLC
• Kathryn C Moff, FNPC
• Muhib Mohammad, PHARMD
• John Darrell Mohr, PHD
• James Thomas Molina, M.D., PH.D.

• Dermatology Physician in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; 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.