Healthcare Provider Details

I. General information

NPI: 1083648919
Provider Name (Legal Business Name): DERMATOLOGY AND ALLERGY CLINIC OF SOUTH LOUISIANA LTD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST STE 2300
LAFAYETTE LA
70506-6765
US

IV. Provider business mailing address

PO BOX 53709
LAFAYETTE LA
70505-3709
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-7546
  • Fax: 337-988-2037
Mailing address:
  • Phone: 337-981-7546
  • Fax: 337-988-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIEN A STEWART
Title or Position: DIRECTOR
Credential: MD
Phone: 337-981-7546