Healthcare Provider Details

I. General information

NPI: 1295448603
Provider Name (Legal Business Name): LOUISIANA MOHS & SKIN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 DUVAL DR
MONROE LA
71201-2986
US

IV. Provider business mailing address

2408 DUVAL DR
MONROE LA
71201-2986
US

V. Phone/Fax

Practice location:
  • Phone: 318-516-2611
  • Fax: 318-516-2711
Mailing address:
  • Phone: 318-516-2611
  • Fax: 318-516-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAITLIN ROBINSON
Title or Position: OWNER
Credential: MD
Phone: 318-547-8055