Provider Demographics
NPI:1750844361
Name:PURE DERMATOLOGY LLC
Entity Type:Organization
Organization Name:PURE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-226-7873
Mailing Address - Street 1:3100 GALLERIA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2196
Mailing Address - Country:US
Mailing Address - Phone:504-226-7873
Mailing Address - Fax:504-704-1639
Practice Address - Street 1:3100 GALLERIA DR STE 203
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2196
Practice Address - Country:US
Practice Address - Phone:504-226-7873
Practice Address - Fax:504-704-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty