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General NPI Number Information
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NPI Number | 1093742769
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Entity Type | Organization
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Legal Business Name | CALAIS DERMATOLOGY ASSOCIATES
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 5220 FLANDERS DRIVE
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City | BATON ROUGE
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State | LA
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Zip | 70808
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Country | US
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Telephone | 225-766-5151
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Fax | 225-766-8216
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Provider Business Mailing Address
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Address Line | 5220 FLANDERS DRIVE
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City | BATON ROUGE
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State | LA
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Zip | 70808
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Country | US
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Telephone | 225-766-5151
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Fax | 225-766-8216
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | JOHN BRETTON BRANTLEY
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Credential | MD
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Telephone | 225-766-5151
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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 |
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License Number State |
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