Integrated Dermatology of Ponchatoula, LLC

NPI #1508234600 in Ponchatoula, Louisiana

Provider Information

NPI Number
1508234600
Entity Type
Organization
Organization Name
Integrated Dermatology of Ponchatoula, LLC
Primary Specialty
Dermatology
Enumeration Date
Sep 4, 2015
Last Updated
May 21, 2019

Practice Location

Address
180 N 5TH ST
ZIP Code
70454-2532
Phone
(985) 370-7546

Authorized Official

Name
JEFFREY QUEEN
Title
MANAGER
Phone
(561) 314-2000

Specialties & Taxonomy Codes

Specialty
Dermatology

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