Prism Dermatology, Pllc

NPI #1043795743 in Southlake, Texas

Provider Information

NPI Number: 1043795743
Entity Type: Organization
Organization Name: Prism Dermatology, Pllc
Primary Specialty: Dermatology
Enumeration Date: Sep 27, 2018
Last Updated: Sep 27, 2018

Practice Location

Address: 925 E SOUTHLAKE BLVD STE 200
City: Southlake
State: Texas
ZIP Code: 76092-1476
Phone: (940) 393-9582

Authorized Official

Name: WALTER GAMAN, MD
Title: PRESIDENT
Phone: (972) 258-7499

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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