Healthcare Provider Details

I. General information

NPI: 1871626903
Provider Name (Legal Business Name): MOHS SURGERY SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LANE SUITE 301
BATON ROUGE LA
70808
US

IV. Provider business mailing address

4950 ESSEN LANE SUITE 301
BATON ROUGE LA
70809
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-9611
  • Fax: 225-763-9699
Mailing address:
  • Phone: 225-763-9611
  • Fax: 225-763-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN D ANTROBUS
Title or Position: OWNER
Credential: M.D.
Phone: 225-763-9611