Provider Demographics
NPI:1821285438
Name:TULANE DERMATOLOGY AFFILIATES
Entity Type:Organization
Organization Name:TULANE DERMATOLOGY AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEPREO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-864-8049
Mailing Address - Street 1:1245 42ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501
Mailing Address - Country:US
Mailing Address - Phone:228-864-8049
Mailing Address - Fax:228-864-7655
Practice Address - Street 1:1245 42ND AVENUE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-864-8049
Practice Address - Fax:228-864-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty