Provider Demographics
NPI:1033381520
Name:HOPKINS DERMATOLOGY APMC
Entity Type:Organization
Organization Name:HOPKINS DERMATOLOGY APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CANOY
Authorized Official - Last Name:SHORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-325-0600
Mailing Address - Street 1:2509 BROADMOOR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2987
Mailing Address - Country:US
Mailing Address - Phone:318-325-0600
Mailing Address - Fax:318-325-0890
Practice Address - Street 1:2509 BROADMOOR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2987
Practice Address - Country:US
Practice Address - Phone:318-325-0600
Practice Address - Fax:318-325-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021601261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG08607Medicare UPIN