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General NPI Number Information
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NPI Number | 1073704391
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Entity Type | Individual
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Provider Name | LORETTA PYLANT GREMILLION M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 2409 BROADMOOR BLVD
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City | MONROE
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State | LA
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Zip | 71201-2964
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Country | US
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Telephone | 318-323-8799
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Fax | 318-323-8815
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Provider Business Mailing Address
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Address Line | 1868 FORSYTHE AVE STE 335
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City | MONROE
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State | LA
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Zip | 71201-3540
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Country | US
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Telephone | 318-251-6216
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Fax | 318-251-6257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 026501
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License Number State | LA
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