| Amy Wolthoff Md Pllc | |
|
6200 Lyndon B Johnson Fwy Ste 110 Dallas TX 75240-6305 | |
| (817) 985-7685 | |
| (833) 337-6329 |
| Full Name | Amy Wolthoff Md Pllc |
|---|---|
| Speciality | Dermatology |
| Location | 6200 Lyndon B Johnson Fwy Ste 110, Dallas, Texas |
| Authorized Official Name and Position | Amanda J Wolthoff (OWNER) |
| Authorized Official Contact | 8179857685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Wolthoff Md Pllc 6200 Lyndon B Johnson Fwy Ste 110 Dallas TX 75240-6305 Ph: (817) 985-7685 | Amy Wolthoff Md Pllc 6200 Lyndon B Johnson Fwy Ste 110 Dallas TX 75240-6305 Ph: (817) 985-7685 |
| NPI Number | 1497472625 |
|---|---|
| Provider Enumeration Date | 10/27/2022 |
| Last Update Date | 11/19/2023 |
| Medicare PECOS PAC ID | 0244600732 |
|---|---|
| Medicare Enrollment ID | O20221227001267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497472625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207N00000X | Dermatology | (* (Not Available)) | Primary |
| Provider Name | Amanda J Wolthoff |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1992016869 PECOS PAC ID: 5799938007 Enrollment ID: I20130118000150 |
| Provider Name | Tashara Lester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720677990 PECOS PAC ID: 1557759156 Enrollment ID: I20211102000102 |
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