=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790582542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CERTIFIED DERM PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2025
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1441 OCHSNER BLVD
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-8110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-400-5551
-----------------------------------------------------
Fax | 985-400-5428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 OCHSNER BLVD
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-8110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-363-8254
-----------------------------------------------------
Fax | 985-363-8255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. ERIK J SOINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 504-621-7158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------