| NPI | 1437901931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STOUT Credentialing Manager 337-315-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 207N00000X Dermatology |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2024-04-05 |