Provider Demographics
NPI:1679905673
Name:DERMATOLOGY OF EAST TEXAS PA
Entity type:Organization
Organization Name:DERMATOLOGY OF EAST TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-531-2850
Mailing Address - Street 1:1777 TROUP HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-0000
Mailing Address - Country:US
Mailing Address - Phone:903-531-2850
Mailing Address - Fax:903-531-2875
Practice Address - Street 1:909 ESE LOOP323 STE 110
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9675
Practice Address - Country:US
Practice Address - Phone:903-531-2850
Practice Address - Fax:903-531-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty