Provider Demographics
NPI:1598948945
Name:MARY CURRY DICKERSON, MD, LLC
Entity Type:Organization
Organization Name:MARY CURRY DICKERSON, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CURRY
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-654-1124
Mailing Address - Street 1:2561 CITIPLACE CT
Mailing Address - Street 2:SUITE 750-156
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:225-201-2112
Practice Address - Street 1:20474 OLD SCENIC HWY
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7300
Practice Address - Country:US
Practice Address - Phone:225-654-1124
Practice Address - Fax:225-654-7079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200824207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4603970650OtherBLUE CROSS
LA4K162Medicare PIN
LA4603970650OtherBLUE CROSS