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SOUTHSIDE DERMATOLOGY PLLC
NPI 1073263380
Dermatology in Broken Arrow, OK

Active since March 28, 2022CLIA 37D2157238 · Certificate of Compliance
3300 S ASPEN AVE STE A, BROKEN ARROW, OK 74012(918) 760-0700 Get Directions Write a Review

NPPES record last updated: March 28, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southside Dermatology Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHSIDE DERMATOLOGY PLLC (NPI 1073263380) is a healthcare organization registered as a dermatology in Broken Arrow, Oklahoma and active in the NPI registry since March 2022. The organization holds a CLIA Certificate of Compliance certificate valid through April 22, 2027 and lists Alison Fischer, Owner, as its authorized official.

NPPES Registry Identity

NPI1073263380
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSOUTHSIDE DERMATOLOGY PLLC
Location Address3300 S ASPEN AVE STE ABroken Arrow, OK 74012-7501
Mailing Address6966 S Utica Ave Ste 225Tulsa, OK 74136-3903 · (918) 492-6333 · Fax (918) 493-9405
Phone(918) 760-0700
Organization SubpartNo
Authorized OfficialAlison FischerOwner · (918) 760-0700
Enumeration DateMarch 28, 2022
NPPES CertifiedMarch 28, 2022
✔ NPI 1073263380 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
3300 S ASPEN AVE STE A, Broken Arrow, OK 74012
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 37D2157238

Southside Dermatology, PLLC · Tulsa, OK
Active · expires Apr 22, 2027
CLIA Number37D2157238
Laboratory TypePhysician Office
Certificate Effective DateApril 23, 2025
Certificate Expiration DateApril 22, 2027
Laboratory DirectorRobert Fischer
Laboratory Phone(918) 760-0700
Laboratory LocationSouthside Dermatology, PLLC720 W 71st Street S, Tulsa, OK 74132
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OSU CENTER FOR HEALTH SCIENCES
Clinic/Center
3300 S ASPEN AVE STE A
BROKEN ARROW, OK 74012
Tulsa County (918) 561-8306
DR. MARY MELISSA MORGAN M.D.
Dermatology (Procedural Dermatology)
3300 S ASPEN AVE STE A
BROKEN ARROW, OK 74012
Tulsa County (918) 770-4599
MS. KATHY HUYNH PA-C
Physician Assistant
3300 S ASPEN AVE STE A
BROKEN ARROW, OK 74012
Tulsa County (918) 770-4599
DREW ENDICOTT DDS AND ASSOCIATES PLLC
Dentist (General Practice)
3300 S ASPEN AVE STE A
BROKEN ARROW, OK 74012
Tulsa County (918) 251-0211

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southside Dermatology PLLC's NPI number?

The NPI number for Southside Dermatology PLLC is 1073263380. It was assigned to this organization in the NPPES registry on March 28, 2022.

Where is Southside Dermatology PLLC located?

Southside Dermatology PLLC is located at 3300 S Aspen Ave Ste A, Broken Arrow, OK 74012. The listed phone number is (918) 760-0700.

What is Southside Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Southside Dermatology PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 37D2157238) is associated with this NPI, valid through April 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southside Dermatology PLLC was last updated on March 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.