Louisiana Dermatology Skin Cancer Center a Medical Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

013630 Issued in LA

Legal business name

LOUISIANA DERMATOLOGY SKIN CANCER CENTER A MEDICAL CORPORATION

Practice address

201 McMillan Rd
West Monroe, LA 71291-5321

Phone

(318) 387-6622

Fax

(318) 387-6030

NPI assigned

Sep 13, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Susan S Walsworth

Title

Office Manager

Phone

(318) 387-6622

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408579200000",
    "number": "1356446801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 MCMILLAN RD",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712915321",
            "telephone_number": "318-387-6622",
            "fax_number": "318-387-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MCMILLAN RD",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712915321",
            "telephone_number": "318-387-6622",
            "fax_number": "318-387-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA DERMATOLOGY SKIN CANCER CENTER A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-08-21",
        "status": "A",
        "authorized_official_last_name": "WALSWORTH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-387-6622",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "LA",
            "license": "013630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVID WALSWORTH MD NPI #",
            "identifier": "1396704904",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1307360",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "436889984A",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayde Long, SLP
• Patchez Long, LOTR
• Louisiana Center for Women'S Health, LLC
• Louisiana CVS Pharmacy LLC
• Louisiana CVS Pharmacy, L.L.C.
• Louisiana Medic Transport LLC
• Louisiana Pharmacy LLC
• Louisiana Re-Entry & Rehabilitation Services- West Monroe
• Farren Lowe
• Whitney Marie Lowe, M.A., CCC-SLP

• Dermatology Physician in West Monroe, LA
• Providers in West Monroe, LA by specialty
• Dermatology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; 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.