# ESTHETIC MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235643891
- **Authorized official:** MRS. JENNIFER ROBIN BONNEY (MANAGER/ BILLING)
- **Authorized official phone:** (228) 254-0495

## Contact information

- **Practice address:** 3769 PONTCHARTRAIN DR STE 3, SLIDELL, LA 70458-4852
- **Practice address phone:** (985) 641-5476
- **Mailing address:** 3769 PONTCHARTRAIN DR STE 3, SLIDELL, LA 70458-4852
- **Mailing address phone:** (985) 641-5476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | MD016771 | LA | — |
| 207ND0900X | Dermatopathology Physician | 16771 | LA | — |
| 207Q00000X | Family Medicine Physician | MD.206408 | LA | Yes |

## Other

- **Enumeration date:** 11/18/2017
- **Last updated:** 11/18/2017