Dermatology Place PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G1907 Issued in TX

Legal business name

DERMATOLOGY PLACE PA

Practice address

1000 W Randol Mill Road
Arlington, TX 76012-2512

Phone

(817) 261-9665

Fax

(817) 795-5750

NPI assigned

Dec 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dudley Winslow Goetz, DO

Title

Physician Owner

Phone

(817) 261-9665

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1447432133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W RANDOL MILL ROAD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760122512",
            "telephone_number": "817-261-9665",
            "fax_number": "817-795-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W RANDOL MILL ROAD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760122512",
            "telephone_number": "817-261-9665",
            "fax_number": "817-795-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY PLACE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "GOETZ",
        "authorized_official_first_name": "DUDLEY",
        "authorized_official_middle_name": "WINSLOW",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "817-261-9665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "G1907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP ID NUMBER",
            "identifier": "00H55N",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jitendra M Deora
• Vijeet Deora, PHARMD
• Department of State Health Services
• Steven Dequeant, LCSW
• Dermatology & Cutaneous Surgery PLLC
• Dermone Dermatology Associates of Texas PA
• Desired Primary Healthcare LLC
• Chaka Desouza, B.S.N. R.N.
• Destination Life LLC
• Destination Life LLC

• Dermatology Physician in Arlington, TX
• Providers in Arlington, 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 15, 2010; 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.