Brazosport Dermatology Clinic PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

F1894 Issued in TX

Legal business name

BRAZOSPORT DERMATOLOGY CLINIC PA

Practice address

Brazosport Dermatology Clinic PA
215 Oak Drive South Ste C
Lake Jackson, TX 77566

Phone

(979) 297-6458

Fax

(979) 297-0076

NPI assigned

Aug 18, 2006

Last updated

Dec 30, 2010By 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

Frank A Peltier, MDNPI 1154515740

Title

President

Phone

(979) 297-6458

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 3

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.

• Frank Adolph Peltier, M.D.

  • Specialist
  • Lake Jackson, TX
  • NPI 1154515740
  NPD (past) Authorized official
• Francis Dang, PA-C, MPH, RD, LD

  • Physician Assistant
  • Lake Jackson, TX
  • NPI 1194365148
  NPD (past)
• Paul Thomas Docis, PA-C

  • Physician Assistant
  • Houston, TX
  • NPI 1790804946
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293667200000",
    "number": "1457465452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 OAK DR S",
            "address_2": "STE C",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665617",
            "telephone_number": "979-297-6458",
            "fax_number": "979-297-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BRAZOSPORT DERMATOLOGY CLINIC PA",
            "address_2": "215 OAK DRIVE SOUTH STE C",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "77566",
            "telephone_number": "979-297-6458",
            "fax_number": "979-297-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOSPORT DERMATOLOGY CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2010-12-30",
        "status": "A",
        "authorized_official_last_name": "PELTIER",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-297-6458",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "F1894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035781601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brazos Eye Care LLC
• Brazos Primary Care Associates
• Brazos River Emergency Physicians PLLC
• Brazosport Cardiology, P.a. (Pearland Heart Institute)
• Brazosport Clinical Lab
• Brazosport Ear, Nose & Throat Clinic, PA
• Brazosport Eye Facility, Inc. (Brazosport Eye Institute)
• Brazosport Health Alliance
• Brazosport Health Alliance
• Brazosport Pediatric Clinic, P.a.

• Dermatology Physician in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.