Organization
ESTHETIC MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER ROBIN BONNEY (MANAGER/ BILLING)
(228) 254-0495
Entity
Organization
Contact information
Practice address
3769 PONTCHARTRAIN DR STE 3, SLIDELL, LA 70458-4852
(985) 641-5476
Mailing address
3769 PONTCHARTRAIN DR STE 3, SLIDELL, LA 70458-4852
(985) 641-5476
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MD016771
LA
207ND0900X
Dermatopathology Physician
16771
LA
207Q00000X
Family Medicine Physician
Primary
MD.206408
LA
Other
Enumeration date
11/18/2017
Last updated
11/18/2017
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