Provider Demographics
NPI:1538257050
Name:MEDICAL CENTER DERMATOLOGY, P.A.
Entity type:Organization
Organization Name:MEDICAL CENTER DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:BASLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-799-1129
Mailing Address - Street 1:7505 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4520
Mailing Address - Country:US
Mailing Address - Phone:713-799-1129
Mailing Address - Fax:713-799-1023
Practice Address - Street 1:7505 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4520
Practice Address - Country:US
Practice Address - Phone:713-799-1129
Practice Address - Fax:713-799-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0163207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty