Unknown Individual – Dermatology Physician, NPI 1942309620

Dermatology Physician

Unknown Individual is a healthcare provider. based in Beaumont, Texas. specializing in Dermatology Physician. They hold a License No. J3153 (TX). The NPI Number for Unknown Individual is 1942309620

Main info

Organization

Inactive

55 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1942309620

Phone

(409) 835-4790

Address

3485 FANNIN ST

Deactivation Date

30 October 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

Graduation Year

1971 (55 years ago)

PAC ID

5799827796

Professional Enrollment ID

I20100128000261

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

3485, Fannin Street, Beaumont, Jefferson County, Texas, 77701, United States
BEAUMONT, TX 777013807
Phone: (409) 835-4790
Fax: (409) 835-2496
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 77701)

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Provider's Procedures

Unknown Individual performs procedures in Dermatology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
DERMATOLOGY	TX	13132	Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet	20	19
DERMATOLOGY	TX	17003	Destruction of 2-14 skin growths	2085	379

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Frequently asked questions

What identifier follows Unknown Individual across health systems?

The NPI 1942309620 uniquely identifies Unknown Individual in U.S. healthcare data.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Dermatology Physician. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Beaumont, Texas in registry-derived data.

What is the difference between NPI and a medical license?

An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.