Skin Surgery Center, PA

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

M5353 Issued in TX

Legal business name

SKIN SURGERY CENTER, PA

Practice address

6208 Colleyville Blvd
Suite 100
Colleyville, TX 76034-6223

Phone

(817) 924-5200

Fax

(817) 924-5266

NPI assigned

Feb 11, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Diego E. Marra, M.D.

Title

Director

Phone

(817) 924-5200

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1265846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265846400000",
    "number": "1811229180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 S HULEN ST",
            "address_2": "SUITE 124-228",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761091929",
            "telephone_number": "817-924-5200",
            "fax_number": "817-924-5266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6208 COLLEYVILLE BLVD",
            "address_2": "SUITE 100",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760346223",
            "telephone_number": "817-924-5200",
            "fax_number": "817-924-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN SURGERY CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-11",
        "last_updated": "2010-02-11",
        "status": "A",
        "authorized_official_last_name": "MARRA",
        "authorized_official_first_name": "DIEGO",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "817-924-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TX",
            "license": "M5353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Colleyville, TX
• Providers in Colleyville, TX by specialty
• MOHS-Micrographic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.