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NPI Code Detail

MEDICARE: RED RIVER DERMATOLOGY

MEDICARE: RED RIVER DERMATOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician025604LA

General Provider Information

NPI Number : 1386790376
Entity Type Code : Organization
Provider Name (Legal Business Name) : RED RIVER DERMATOLOGY
Provider Business Mailing Address
First Line : 3335 PRESCOTT RD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-3916
Country : US
Telephone Number : 318-442-9395
Fax Number : 318-442-9548
Provider Business Practice Location Address
First Line : 3335 PRESCOTT RD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-3916
Country : US
Telephone Number : 318-442-9395
Fax Number : 318-442-9548
Authorized Official
Title or Position : OWNER
Name : DR. ELIZABETH PRATT BERRY LONG
Credential : MD
Telephone Number : 318-442-9395
Provider Enumeration Date : 01/25/2007
Last Update Date : 08/22/2020

Similar Medicare Providers

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1114138658 — DR. MARGO LASHAE THOMAS M.D.
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Practice Fax:
1952757304 — JANICE DARA MD
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1649792045 — REBECCA ANNE BARTLETT APRN
Practice Location Address:
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Directions to “RED RIVER DERMATOLOGY ” Practice Location

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