Provider Demographics
NPI:1083648919
Name:DERMATOLOGY AND ALLERGY CLINIC OF SOUTH LOUISIANA LTD APMC
Entity Type:Organization
Organization Name:DERMATOLOGY AND ALLERGY CLINIC OF SOUTH LOUISIANA LTD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-981-7546
Mailing Address - Street 1:PO BOX 53709
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3709
Mailing Address - Country:US
Mailing Address - Phone:337-981-7546
Mailing Address - Fax:337-988-2037
Practice Address - Street 1:4212 W CONGRESS ST
Practice Address - Street 2:STE 2300
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6765
Practice Address - Country:US
Practice Address - Phone:337-981-7546
Practice Address - Fax:337-988-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941344Medicaid
LA1941344Medicaid
LACJ3222Medicare PIN