Provider Demographics
NPI:1447283890
Name:DERMATOLOGY OF THE SOUTHWEST PA
Entity type:Organization
Organization Name:DERMATOLOGY OF THE SOUTHWEST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUZICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-772-7202
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 956
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-772-7202
Mailing Address - Fax:713-772-7290
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE 956
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-772-7202
Practice Address - Fax:713-772-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9471261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001AZMedicare ID - Type Unspecified