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1912190646 NPI number — LOUISIANA DERMATOLOGY ASSOCIATES, LLC

NPI Number: 1912190646
Health Care Provider/Practitioner: LOUISIANA DERMATOLOGY ASSOCIATES, LLC

Information about “1912190646” NPI (LOUISIANA DERMATOLOGY ASSOCIATES, LLC) exists in 1912190646 in HTML format HTML  |  1912190646 in plain Text format TXT  |  1912190646 in PDF (Portable Document Format) PDF  |  1912190646 in an XML format XML  formats.

NPI Number : 1912190646 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912190646",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LOUISIANA DERMATOLOGY ASSOCIATES, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1014 W ST.CLARE BOULEVARD",
    "SecondLineMailingAddress": "SUITE 1040",
    "MailingAddressCityName": "GONZALES",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "70737",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "225-743-2090",
    "MailingAddressFaxNumber": "225-743-2093",
    "FirstLinePracticeLocationAddress": "1014 W. ST. CLARE BOULEVARD",
    "SecondLinePracticeLocationAddress": "SUITE 1040",
    "PracticeLocationAddressCityName": "GONZALES",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70737",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "225-743-2090",
    "PracticeLocationAddressFaxNumber": "225-743-2093",
    "EnumerationDate": "08/27/2007",
    "LastUpdateDate": "08/27/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "IMES",
    "AuthorizedOfficialFirstName": "GLENDA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRACTICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "225-927-5663",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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