Provider Demographics
NPI:1811038433
Name:HUBBELL DERMATOLOGY AND AESTHETICS A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HUBBELL DERMATOLOGY AND AESTHETICS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:ACADIANA DERMATOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HUBBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-981-6065
Mailing Address - Street 1:309 SETTLERS TRACE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3062
Mailing Address - Country:US
Mailing Address - Phone:337-981-6065
Mailing Address - Fax:337-981-6066
Practice Address - Street 1:309 SETTLERS TRACE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3062
Practice Address - Country:US
Practice Address - Phone:337-981-6065
Practice Address - Fax:337-981-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty