| Organization Name: | LONE STAR STATE DERMATOLOGY CLINIC PLLC |
| NPI Number: | 1053723239 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELLE NICOLE REYES (OFFICE MANAGER) |
| Mailing Address: | 11485 Toepperwein Rd Suite 2 Live Oak |
| State: | TX US |
| Postal Code: | 782333143 |
| Phone Number: | 2106513233 |
| Fax Number: | 2106513234 |
| NPI Enumeration Date: | 05/22/2014 |
| NPI Last Update Date: | 11/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207NS0135X |
| License Number: | K8022 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Dermatology |
| Taxonomy Specialization: | Procedural Dermatology |
| Taxonomy Definition: | Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). |