Healthcare Provider Details

I. General information

NPI: 1790146223
Provider Name (Legal Business Name): JOHN CHAPMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RUE FONTAINE BLDG 4
LAFAYETTE LA
70508-5744
US

IV. Provider business mailing address

101 RUE FONTAINE BLDG 4
LAFAYETTE LA
70508-5744
US

V. Phone/Fax

Practice location:
  • Phone: 337-385-5861
  • Fax: 337-385-5862
Mailing address:
  • Phone: 337-385-5861
  • Fax: 337-385-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.32941
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD.32941
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD.204848
License Number StateLA

VIII. Authorized Official

Name: DR. JOHN CHARLES CHAPMAN
Title or Position: CEO
Credential: MD
Phone: 337-385-5861