Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mountain West Derm - Blackhart PLLC

Organization Dermatology Physician · NPI 1366018848

Mountain West Derm - Blackhart PLLC is a Dermatology Physician in Georgetown, Texas. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
3
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4513 Williams Dr
Georgetown, TX 78633-1302
Phone: (512) 930-3909
Fax: (512) 240-5469
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X
MOHS-Micrographic Surgery Physician Taxonomy 207ND0101X
Dermatopathology Physician Taxonomy 207ND0900X

Record details

NPI number1366018848
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Bret Blackhart — President · (775) 336-3624
Other names Vitalogy Skincare
NPI enumeratedJune 3, 2021
Last updated in NPPESJune 14, 2021
Certification dateJune 14, 2021
Mailing address4513 Williams Dr, Georgetown, TX 78633-1302

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