Summit Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

K9734 Issued in TX

Legal business name

SUMMIT DERMATOLOGY, PLLC

Practice address

1038 S Fleishel Ave
Tyler, TX 75701-2044

Phone

(903) 593-9474

Fax

(903) 593-9477

NPI assigned

Oct 17, 2017

Organization subpart

No

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

Authorized official

Name

Jason L Blaser, MD

Title

President

Phone

(903) 593-9474

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508198400000",
    "number": "1912418963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1038 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012044",
            "telephone_number": "903-593-9474",
            "fax_number": "903-593-9477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1038 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012044",
            "telephone_number": "903-593-9474",
            "fax_number": "903-593-9477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A",
        "authorized_official_last_name": "BLASER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-593-9474",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "K9734",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": "K9734",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Mark Sullivan, R.PH.
• Kimberly J Sulser
• Norman Carl Sulser, M.D.
• Mohammad Tanvir Sultan, D.O.
• Taja S Summers
• Summit Psychological Services, PLLC
• Lian Sun
• Zahide Sunal, PH.D.,LPC, NCC
• Tammie Sunderman
• Sunlite Healthcare Services , Inc .

• Dermatology Physician in Tyler, TX
• Providers in Tyler, 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 17, 2017; 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.