Fresh Dermatology, P.a.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

L8216 Issued in TX

Legal business name

FRESH DERMATOLOGY, P.A.

Practice address

1008 RR 620 S Ste 101
Lakeway, TX 78734-5632

Phone

(512) 615-5600

Fax

(512) 615-5606

NPI assigned

Sep 15, 2013

Organization subpart

No

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

Authorized official

Name

Candace Thrash Nguyen, M.D.

Title

President

Phone

(512) 615-5600

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Amy T. Moor, CRNA

  • Certified Registered Nurse Anesthetist
  • Boston, MA
  • NPI 1013160415
  NPD

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

{
    "created_epoch": "1379203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379203200000",
    "number": "1962838524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 RR 620 S STE 101",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345632",
            "telephone_number": "512-615-5600",
            "fax_number": "512-615-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 RR 620 S STE 101",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345632",
            "telephone_number": "512-615-5600",
            "fax_number": "512-615-5606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-15",
        "last_updated": "2013-09-15",
        "status": "A",
        "authorized_official_last_name": "THRASH NGUYEN",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-615-5600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "L8216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Foster
• Jacqueline Gene Frame, LVN
• Reese Franklin, PT, DPT
• Daniel V Freeland, DO
• Matthew Blake Freeman, M.D.
• David James Gabriel, M.D.
• Garima Gandhir, D.O.
• Claire Elizabeth Ganschow, MA, BCBA, LBA
• Erica Teresa Garcia
• Stacy Jean Garland, M.A., LPC

• 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 Sep 15, 2013; 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.