Provider Demographics
NPI:1447619291
Name:BLACKBURN WOOLFOLK DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:BLACKBURN WOOLFOLK DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANEEQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLFOLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-630-5256
Mailing Address - Street 1:4520 N MACARTHUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-1235
Mailing Address - Country:US
Mailing Address - Phone:214-630-5256
Mailing Address - Fax:214-630-2251
Practice Address - Street 1:4520 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-1235
Practice Address - Country:US
Practice Address - Phone:214-630-5256
Practice Address - Fax:214-630-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3314207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty