MEDICARE: IBERIA 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
1	207N00000X	Dermatology Physician	023184	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518094010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBERIA DERMATOLOGY

Provider Business Mailing Address
First Line	:	PO BOX 10938
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70562-0938
Country	:	US
Telephone Number	:	337-560-1200
Fax Number	:	337-560-5554

Provider Business Practice Location Address
First Line	:	602 N LEWIS ST
Second Line	:	SUITE 600
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2093
Country	:	US
Telephone Number	:	337-560-1200
Fax Number	:	337-560-5554

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VENETIA MARIE NICOLE PATOUT
Credential	:	M.D.
Telephone Number	:	337-560-1200

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	10/01/2007

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Directions to “IBERIA DERMATOLOGY ” Practice Location

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