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General NPI Number Information
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NPI Number | 1518100312
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Entity Type | Organization
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Legal Business Name | CRESCENT CITY DERMATOLOGY, LLC
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 120 MEADOWCREST ST SUITE 460
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City | GRETNA
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State | LA
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Zip | 70056-5255
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Country | US
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Telephone | 614-937-0319
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 S PETERS ST UNIT 404
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City | NEW ORLEANS
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State | LA
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Zip | 70130-1759
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Country | US
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Telephone | 614-937-0319
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | DR. STEPHEN JOHN KLINGER
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Credential | M.D., M.P.H.
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Telephone | 614-937-0319
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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 | 200999
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License Number State | LA
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