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General NPI Number Information
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NPI Number | 1518094010
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Entity Type | Organization
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Legal Business Name | IBERIA DERMATOLOGY
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 602 N LEWIS ST SUITE 600
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City | NEW IBERIA
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State | LA
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Zip | 70563-2093
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Country | US
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Telephone | 337-560-1200
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Fax | 337-560-5554
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Provider Business Mailing Address
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Address Line | PO BOX 10938
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City | NEW IBERIA
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State | LA
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Zip | 70562-0938
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Country | US
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Telephone | 337-560-1200
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Fax | 337-560-5554
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Authorized Official
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Title or Position | OWNER
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Name | DR. VENETIA MARIE NICOLE PATOUT
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Credential | M.D.
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Telephone | 337-560-1200
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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 | 023184
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License Number State | LA
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