Provider Demographics
NPI:1326037649
Name:LOUISIANA DERMATOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LOUISIANA DERMATOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-490-0812
Mailing Address - Street 1:10154 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2725
Mailing Address - Country:US
Mailing Address - Phone:225-490-0812
Mailing Address - Fax:225-490-0813
Practice Address - Street 1:10154 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2725
Practice Address - Country:US
Practice Address - Phone:225-490-0812
Practice Address - Fax:225-490-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty