| NPI | 1053579862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD L. PRATHER Owner 225-303-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: LA MD.200242) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA MD.200242) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: LA MD.200242) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: LA MD.200242) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2023-01-26 |