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General NPI Number Information
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NPI Number | 1922863067
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Entity Type | Organization
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Legal Business Name | LUXE COSMETIC SURGERY LLC
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 3704 NORTH BLVD STE 3
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3658
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Country | US
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Telephone | 318-206-5893
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Fax |
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Provider Business Mailing Address
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Address Line | 426 N MONROE ST
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City | MARKSVILLE
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State | LA
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Zip | 71351-2356
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JODY MICHAEL JOHNSON
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Credential | DO
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Telephone | 606-331-2521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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