Organization Name: | ADAGIO DERMATOLOGY AND AESTHETICS, P.A. |
NPI Number: | 1225023070 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAURA JENNIFER HAYGOOD (PRESIDENT) |
Mailing Address: | 455 Rice Road Ste. 104 Tyler |
State: | TX US |
Postal Code: | 757033604 |
Phone Number: | 9035973376 |
Fax Number: | 9035267703 |
NPI Enumeration Date: | 09/19/2005 |
NPI Last Update Date: | 08/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | K3905 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |