Healthcare Provider Details

I. General information

NPI: 1053400416
Provider Name (Legal Business Name): GRAFTON DERMATOLOGY AND COSMETIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BAYOU GARDENS BLVD
HOUMA LA
70364-1434
US

IV. Provider business mailing address

327 BAYOU GARDENS BLVD
HOUMA LA
70364-1434
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-5000
  • Fax: 985-876-5280
Mailing address:
  • Phone: 985-876-5000
  • Fax: 985-876-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number023735
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA10451
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number022623
License Number StateLA

VIII. Authorized Official

Name: DR. LEE HOYE GRAFTON
Title or Position: CEO
Credential: MD
Phone: 985-876-5000