Virt Derm, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

VIRT DERM, PLLC

Doing business as

Virtual Dermatology

Practice address

4516 Lakota TRL
Mansfield, TX 76063-2312

Phone

(281) 686-3665

NPI assigned

Jul 23, 2017

Last updated

Jul 29, 2020By 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

Ryan Pham

Title

Managing Member

Phone

(817) 718-3571

Specialties & licenses 1

Addresses

Other names 1

• Virtual Dermatology Doing business as

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

{
    "created_epoch": "1500768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1437672334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 LAKOTA TRL",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 LAKOTA TRL",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632312",
            "telephone_number": "281-686-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRT DERM, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-23",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-718-3571"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virtual Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Virtual Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.