Provider Type Icon

PREMIER PROCEDURAL DERMATOLOGY PLLC NPI 1053969287


NPI Information

NPI: 1053969287
Provider Name: PREMIER PROCEDURAL DERMATOLOGY PLLC
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 45D2172119

Address:
1651 ROCK PRAIRIE RD STE 103
COLLEGE STATION, TX
ZIP 77845
Phone: (979) 314-5400
Get Directions

PREMIER PROCEDURAL DERMATOLOGY PLLC is a mohs-micrographic surgery dermatology in College Station, TX. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. PREMIER PROCEDURAL DERMATOLOGY PLLC NPI is 1053969287. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1651 ROCK PRAIRIE RD STE 103
COLLEGE STATION, TX
ZIP 77845-652
Phone: (979) 314-5400
Fax: (979) 704-5603

The provider's authorized official is Ryan William Ahern .
The authorized official title is Provider/owner and has the following contact phone number (979) 314-5400.

The CLIA number assigned to this NPI record is 45D2172119 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/30/2019 and was last updated on 4/3/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207ND0101XDermatologyMOHS-Micrographic SurgeryYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.