Healthcare Provider Details

I. General information

NPI: 1164773172
Provider Name (Legal Business Name): LAFAYETTE DERMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RUE FONTAINE BLDG 1
LAFAYETTE LA
70508-5788
US

IV. Provider business mailing address

101 RUE FONTAINE BLDG 1
LAFAYETTE LA
70508-5788
US

V. Phone/Fax

Practice location:
  • Phone: 337-524-1700
  • Fax:
Mailing address:
  • Phone: 337-524-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRANKIE G RHOLDON
Title or Position: DIRECTOR
Credential: MD
Phone: 337-524-1700