Basic Information
| Provider Information | |||||||||
| NPI: | 1619099124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OASIS DERMATOLOGY GROUP, PLLC | ||||||||
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| OtherOrganizationName: | DERMATOLOGY CLINIC OF MCALLEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 BUDDY OWENS BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9569710404 | ||||||||
| FaxNumber: | 9569710408 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 BUDDY OWENS BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9569710404 | ||||||||
| FaxNumber: | 9569710408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | LIN | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | JUI HAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9569710404 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | L4533 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 179339001 | 05 | TX | MEDICAID |