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General NPI Number Information
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NPI Number | 1801007307
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Entity Type | Organization
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Legal Business Name | DURA MATER, INC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 GAUSE BLVD SUITE 201
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City | SLIDELL
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State | LA
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Zip | 70458-2800
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Country | US
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Telephone | 985-690-0135
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Fax | 985-690-0136
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Provider Business Mailing Address
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Address Line | 700 GAUSE BLVD SUITE 201
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City | SLIDELL
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State | LA
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Zip | 70458-2800
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Country | US
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Telephone | 985-690-0135
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Fax | 985-690-0136
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Authorized Official
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Title or Position | CEO
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Name | DR. BRYANT GERARD GEORGE SR.
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Credential | M.D.
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Telephone | 985-690-0135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 018940
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License Number State | LA
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