NPIMap

Organization Active NPI

Esthetic MD

  • Family Medicine Physician
  • Slidell, LA
National Provider Identifier
1235643891
Registry record updated Nov 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD.206408 Issued in LA
Legal business name
ESTHETIC MD
Practice address
3769 Pontchartrain Dr Ste 3
Slidell, LA 70458-4852
Phone
(985) 641-5476
NPI assigned
Nov 18, 2017
Last updated
Nov 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jennifer Robin Bonney
Title
Manager/ Billing
Phone
(228) 254-0495

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD016771 LA
Dermatopathology Physician 207ND0900X 16771 LA
Family Medicine Physician 207Q00000X MD.206408 LA Primary

Addresses

Primary practice location

3769 Pontchartrain Dr Ste 3
Slidell, LA 70458-4852

Mailing address

3769 Pontchartrain Dr Ste 3
Slidell, LA 70458-4852
Phone (985) 641-5476

National Provider Directory

National Provider Directory
Tax ID family
Advanced Medical Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3769 Pontchartrain Dr
Ste 3
Slidell, LA 70458
Phone (985) 641-5476

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510963200000",
    "number": "1235643891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3769 PONTCHARTRAIN DR STE 3",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704584852",
            "telephone_number": "985-641-5476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3769 PONTCHARTRAIN DR STE 3",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704584852",
            "telephone_number": "985-641-5476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTHETIC MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-18",
        "last_updated": "2017-11-18",
        "status": "A",
        "authorized_official_last_name": "BONNEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ROBIN",
        "authorized_official_title_or_position": "MANAGER/ BILLING",
        "authorized_official_telephone_number": "228-254-0495",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "LA",
            "license": "MD016771",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "LA",
            "license": "16771",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.206408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.