| Prestige Dermatology Of Alliance, Pllc | |
|
3629 Western Center Blvd Suite 201 Fort Worth TX 76137-1939 | |
| (817) 766-7421 | |
| Not Available |
| Full Name | Prestige Dermatology Of Alliance, Pllc |
|---|---|
| Speciality | Dermatology |
| Location | 3629 Western Center Blvd, Fort Worth, Texas |
| Authorized Official Name and Position | Ryan Pham (MANAGING MEMBER) |
| Authorized Official Contact | 8177667421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prestige Dermatology Of Alliance, Pllc 3629 Western Center Blvd Ste 211 Fort Worth TX 76137-1940 Ph: (817) 766-7422 | Prestige Dermatology Of Alliance, Pllc 3629 Western Center Blvd Suite 201 Fort Worth TX 76137-1939 Ph: (817) 766-7421 |
| NPI Number | 1427415314 |
|---|---|
| Provider Enumeration Date | 01/22/2016 |
| Last Update Date | 01/21/2021 |
| Medicare PECOS PAC ID | 4284930959 |
|---|---|
| Medicare Enrollment ID | O20160307000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427415314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207N00000X | Dermatology | (* (Not Available)) | Primary |
| Provider Name | Jack B Cohen |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1134188279 PECOS PAC ID: 9830221126 Enrollment ID: I20100722000342 |
| Provider Name | Ryan K Pham |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1407173230 PECOS PAC ID: 6406075001 Enrollment ID: I20140912002031 |
| Provider Name | Heather Reagin |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1407260151 PECOS PAC ID: 7517189160 Enrollment ID: I20171226000854 |
| Provider Name | Hong Do |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639683576 PECOS PAC ID: 8426316001 Enrollment ID: I20180103002845 |
| Provider Name | Amy Sanders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093194789 PECOS PAC ID: 0042556573 Enrollment ID: I20190104000125 |
| Provider Name | Nhi Hoai Le |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043670409 PECOS PAC ID: 7810296522 Enrollment ID: I20190816001218 |
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