Brownwood Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

Q1815 Issued in TX

Legal business name

BROWNWOOD DERMATOLOGY PLLC

Doing business as

Epiphany Dermatology PA

Practice address

2504 Crockett Dr
Brownwood, TX 76801-5900

Phone

(325) 646-2929

Fax

(325) 641-0122

NPI assigned

Jun 17, 2015

Last updated

Sep 23, 2016By 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

Gheorghe Pusta

Title

Administrator

Phone

(512) 960-5760

Specialties & licenses 1

Addresses

Other names 1

• Epiphany Dermatology PA Doing business as

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1386025104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 VAUGHT RANCH RD STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787302309",
            "telephone_number": "512-628-0465",
            "fax_number": "512-628-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 CROCKETT DR",
            "city": "BROWNWOOD",
            "state": "TX",
            "postal_code": "768015900",
            "telephone_number": "325-646-2929",
            "fax_number": "325-641-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROWNWOOD DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-17",
        "last_updated": "2016-09-23",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "512-960-5760"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "Q1815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Epiphany Dermatology PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brownwood Allergy Clinic, PLLC
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• Brownwood Brown County Health Department
• Brownwood Clinic PA
• Brownwood Dental PLLS
• Brownwood Family Eyecare, P.a. (Commerce Square Optical)
• Brownwood Hospital LP (Brownwood Regional Medical Center)
• Brownwood Hospital LP (Brownwood Regional Medical Center)
• Brownwood Hospital LP (Brownwood Regional Medical Center)
• Brownwood Hospital LP (Brownwood Regional Medical Center)

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

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