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General NPI Number Information
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NPI Number | 1821285438
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Entity Type | Organization
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Legal Business Name | TULANE DERMATOLOGY AFFILIATES
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 1245 42ND AVENUE
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-864-8049
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Fax | 228-864-7655
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Provider Business Mailing Address
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Address Line | 1245 42ND AVENUE
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-864-8049
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Fax | 228-864-7655
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA E. DEPREO
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Credential |
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Telephone | 228-864-8049
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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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