NPIMap

Organization Active NPI

Louisiana Dermatology Associates, LLC

  • Dermatology Physician
  • Gonzales, LA
National Provider Identifier
1912190646
Registry record updated Aug 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LOUISIANA DERMATOLOGY ASSOCIATES, LLC
Practice address
1014 W. St. Clare Boulevard
Suite 1040
Gonzales, LA 70737
Phone
(225) 743-2090
Fax
(225) 743-2093
NPI assigned
Aug 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2007

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

Authorized official

Name
Glenda Imes
Title
Practice Manager
Phone
(225) 927-5663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1014 W. St. Clare Boulevard
Suite 1040
Gonzales, LA 70737

Mailing address

1014 W St.Clare Boulevard
Suite 1040
Gonzales, LA 70737
Phone (225) 743-2090

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1912190646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 W ST.CLARE BOULEVARD",
            "address_2": "SUITE 1040",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "70737",
            "telephone_number": "225-743-2090",
            "fax_number": "225-743-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 W. ST. CLARE BOULEVARD",
            "address_2": "SUITE 1040",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "70737",
            "telephone_number": "225-743-2090",
            "fax_number": "225-743-2093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA DERMATOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "IMES",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "225-927-5663"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gonzales, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.