NPIMap

Organization Active NPI

Ladera Park Dermatology, P.a.

  • Dermatology Physician
  • Austin, TX
National Provider Identifier
1417010935
Registry record updated Feb 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LADERA PARK DERMATOLOGY, P.A.
Practice address
11671 Jollyville Rd Ste 104
Austin, TX 78759-4141
Phone
(512) 345-3599
Fax
(512) 345-3928
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2013

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

Authorized official

Name
Janet C Dubois, MDNPI 1295797504
Title
President
Phone
(512) 345-3599

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

11671 Jollyville Rd Ste 104
Austin, TX 78759-4141

Mailing address

11671 Jollyville Rd Ste 104
Austin, TX 78759-4141
Phone (512) 345-3599

Other identifiers 1

IdentifierTypeStateIssuer
0001MUOtherTXBLUE CROSS GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

11671 Jollyville Rd
Ste 104
Austin, TX 78759
Phone (512) 345-3599

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361923200000",
    "number": "1417010935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11671 JOLLYVILLE RD STE 104",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594141",
            "telephone_number": "512-345-3599",
            "fax_number": "512-345-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11671 JOLLYVILLE RD STE 104",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594141",
            "telephone_number": "512-345-3599",
            "fax_number": "512-345-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LADERA PARK DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2013-02-27",
        "status": "A",
        "authorized_official_last_name": "DUBOIS",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-345-3599",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "0001MU",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.