Liberty Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

N3356 Issued in TX

Legal business name

LIBERTY DERMATOLOGY, PA

Practice address

7105 Lakeview Pkwy Ste 100
Rowlett, TX 75088-4202

Phone

(972) 475-5300

Fax

(972) 475-5303

NPI assigned

Oct 20, 2011

Organization subpart

No

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

Authorized official

Name

Kien T. Tran, MDNPI 1417158833

Title

President

Phone

(214) 893-9677

Specialties & licenses 1

Addresses

Other names 1

• Liberty Dermatopathology Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kien T. Tran, MD, PHD

  • Dermatology Physician
  • Rockwall, TX
  • NPI 1417158833
  Medicare reassignment Care Compare group NPD Authorized official
• Theresa Thuy Vo, M.D.

  • Dermatology Physician
  • Rowlett, TX
  • NPI 1437592151
  Medicare reassignment Care Compare group NPD
• Alexa Burciaga, MPAS, PA-C

  • Physician Assistant
  • Rowlett, TX
  • NPI 1811747033
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633824000000",
    "number": "1659656759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601799",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753601799",
            "telephone_number": "214-893-9677",
            "fax_number": "972-475-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7105 LAKEVIEW PKWY STE 100",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750884202",
            "telephone_number": "972-475-5300",
            "fax_number": "972-475-5303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6800 Heritage Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Rockwall",
            "state": "TX",
            "postal_code": "750878746",
            "country_code": "US",
            "telephone_number": "972-475-5300",
            "fax_number": "972-475-5303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIBERTY DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-20",
        "last_updated": "2021-10-10",
        "certification_date": "2021-10-10",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "KIEN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-893-9677",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "N3356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Dermatopathology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Liberty Dermatopathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William K. Leslie, M. D.
• Cordell Wayne Lester, DC
• Pam Letourneau, MS
• Olga Levin
• Gwendolyn Lewis, OTR
• Liberty Family Care and Wellness PLLC
• Kim Liebbe, SLP
• Lifegiving Bodies LLC
• Hailey Lindsey
• Link Medical Partners, PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.