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General NPI Number Information
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NPI Number | 1952136111
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Entity Type | Organization
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Legal Business Name | DERMA LLC
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 6411 PERKINS RD STE 202
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City | BATON ROUGE
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State | LA
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Zip | 70808-4125
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Country | US
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Telephone | 225-800-6869
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Fax |
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Provider Business Mailing Address
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Address Line | 6411 PERKINS RD STE 202
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City | BATON ROUGE
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State | LA
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Zip | 70808-4125
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Country | US
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Telephone | 225-800-6869
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHAD PRATHER
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Credential | MD
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Telephone | 225-800-6869
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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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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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