OrganizationActive
Lone Star State Dermatology Clinic PLLC
NPI 1053723239 · Procedural Dermatology Physician · Live Oak, TX
Provider details
- NPI number
- 1053723239
- Entity type
- Organization
- Primary specialty
- Procedural Dermatology PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Myra Peacock, Office Manager
- License
- K8022 (TX)
Practice location
11101 Toepperwein Rd
Live Oak, TX 78233-3048
Phone: (210) 651-3233
Fax: (210) 651-3234
Mailing address
11101 Toepperwein Rd
Live Oak, TX 78233-3048
Registry dates
- Enumerated
- 2014-05-22
- Last updated
- 2023-12-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.