South Tyler Dermatology

Primary specialty

SpecialistTaxonomy code 174400000X

License

H2238 Issued in TX

Legal business name

SOUTH TYLER DERMATOLOGY

Practice address

5791 Copeland Rd
Tyler, TX 75703-3905

Phone

(903) 509-2020

Fax

(903) 509-2355

NPI assigned

Jul 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dannise Beckley, M.D

Title

Physcian/ Owner

Phone

(903) 509-2020

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1568661908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5791 COPELAND RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033905",
            "telephone_number": "903-509-2020",
            "fax_number": "903-509-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5791 COPELAND RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033905",
            "telephone_number": "903-509-2020",
            "fax_number": "903-509-2355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TYLER DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "BECKLEY",
        "authorized_official_first_name": "DANNISE",
        "authorized_official_title_or_position": "PHYSCIAN/ OWNER",
        "authorized_official_telephone_number": "903-509-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "H2238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Anthony Sorto, M.D.
• Brianna Souder, DO
• South Limestone Hospital District
• South Limestone Hospital District
• South Park Care & Rehab LLC
• South Tyler Family Dentistry PLLC
• Southland Legend Pharmacy
• Southwest LTC - Reunion Plaza LLC
• Southwest LTC - Waterton LLC
• Stephen C Spain, MD

• Specialist in Tyler, TX
• Providers in Tyler, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.