Lakeway Dermatology and Skin Cancer

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

K5280 Issued in TX

Legal business name

LAKEWAY DERMATOLOGY AND SKIN CANCER

Practice address

1313 RR 620 South
Suite 201
Lakeway, TX 78734-6333

Phone

(512) 263-0057

Fax

(512) 263-0221

NPI assigned

Oct 18, 2006

Organization subpart

No

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

Authorized official

Name

Mary Ana Cunningham, M.D.

Title

President

Phone

(512) 263-0057

Specialties & licenses 1

Addresses

Other names 1

• MARY ANA CUNNINGHAM Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Oliver Street 5.01(a) Inc.

  • Dermatology Physician
  • Dallas, TX
  • NPI 1457695413

  Member Of

  NPD member

Locations

Practitioners 1

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

• Caroline Gay Carr, PA-C

  • Medical Physician Assistant
  • Lakeway, TX
  • NPI 1083767693
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1780765172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3464 RR 620 S",
            "city": "BEE CAVE",
            "state": "TX",
            "postal_code": "787386805",
            "telephone_number": "512-263-0057",
            "fax_number": "512-263-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 RR 620 SOUTH",
            "address_2": "SUITE 201",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787346333",
            "telephone_number": "512-263-0057",
            "fax_number": "512-263-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWAY DERMATOLOGY AND SKIN CANCER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-263-0057",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "K5280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARY ANA CUNNINGHAM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lake Travis Oral & Maxillofacial Surgery, PLLC.
• Lake Travis Pediatric Dentistry
• Lake Travis Surgery Center LLC
• Lakeway Ambulatory Surgery Center, LLC
• Lakeway Dental Solutions. LLC
• Lakeway Era Acquistion Partners LLC
• Lakeway Era Acquistion Partners LLC
• Lakeway Eye Center PC
• Lakeway Eye Physicians and Surgeons
• Lakeway Health & Wellness Chiropractic, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; 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.