MEDICARE: HOPKINS DERMATOLOGY APMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	MD.021601	LA

General Provider Information

NPI Number	:	1033381520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPKINS DERMATOLOGY APMC

Provider Business Mailing Address
First Line	:	2509 BROADMOOR BLVD
Second Line	:	SUITE A
City	:	MONROE
State	:	LA
Zip	:	71201-2987
Country	:	US
Telephone Number	:	318-325-0600
Fax Number	:	318-325-0890

Provider Business Practice Location Address
First Line	:	2509 BROADMOOR BLVD
Second Line	:	SUITE A
City	:	MONROE
State	:	LA
Zip	:	71201-2987
Country	:	US
Telephone Number	:	318-325-0600
Fax Number	:	318-325-0890

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LISA CANOY SHORE
Credential	:
Telephone Number	:	318-325-0600

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	06/30/2023

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