Provider Demographics
NPI:1366199952
Name:PATAGONIA DERMATOLOGY PLLC
Entity type:Organization
Organization Name:PATAGONIA DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:214-556-1222
Mailing Address - Street 1:1400 N COIT RD STE 501
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6657
Mailing Address - Country:US
Mailing Address - Phone:214-556-1222
Mailing Address - Fax:214-556-2923
Practice Address - Street 1:1400 N COIT RD STE 501
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6657
Practice Address - Country:US
Practice Address - Phone:214-556-1222
Practice Address - Fax:214-556-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty