Provider Demographics
NPI:1780663419
Name:DERMATOLOGY ASSOCIATES OF SWLA LLC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF SWLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-310-2380
Mailing Address - Street 1:2000 TYBEE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4171
Mailing Address - Country:US
Mailing Address - Phone:337-433-7272
Mailing Address - Fax:337-433-0730
Practice Address - Street 1:2000 TYBEE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4171
Practice Address - Country:US
Practice Address - Phone:337-433-7272
Practice Address - Fax:337-433-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty