Cosmetic Surgery of DFW PLLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

COSMETIC SURGERY OF DFW PLLC

Practice address

800 12TH Ave Ste 100
Fort Worth, TX 76104-2519

Phone

(817) 529-4314

Fax

(844) 210-1095

NPI assigned

Apr 28, 2021

Organization subpart

No

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

Authorized official

Name

Dustin Derrick, MD

Title

Owner

Phone

(817) 529-4314

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1497337471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 12TH AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042519",
            "telephone_number": "817-529-4314",
            "fax_number": "844-210-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 12TH AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042519",
            "telephone_number": "817-529-4314",
            "fax_number": "844-210-1095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC SURGERY OF DFW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-529-4314",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coryell County Memorial Hospital Authority
• Coryell County Memorial Hospital Authority
• Tanya Danielle Corza
• Heather Elizabeth Cosby, LCDC
• Michael D Cosgrove, DDS, PC
• Cosmos Neuromonitoring LLC
• Chase Dee Cosper, PHARMD
• Markay Cosper
• Mary Bassett Costas, L.P.C.
• Costco Wholesale Corporation

• Plastic Surgery Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Plastic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.