Provider Demographics
NPI:1235678558
Name:FAMILY DERMATOLOGY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:FAMILY DERMATOLOGY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:NORTHCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-832-6612
Mailing Address - Street 1:3421 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3759
Mailing Address - Country:US
Mailing Address - Phone:504-832-6612
Mailing Address - Fax:504-832-6613
Practice Address - Street 1:3421 N CAUSEWAY BOULEVARD
Practice Address - Street 2:SUITE 202
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3759
Practice Address - Country:US
Practice Address - Phone:504-832-6612
Practice Address - Fax:504-832-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA207N00000XOtherTAXONOMY