Individual
MS. ELIZABETH M DIMITRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2104 GAUSE BLVD W, STE. A, SLIDELL, LA 70460-4130
(985) 643-4575
(985) 643-4513
Mailing address
2104 GAUSE BLVD W, STE. A, SLIDELL, LA 70460-4130
(985) 643-4575
(985) 643-4513
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
14885R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09685205
—
MS
05
—
1150126
—
LA
Enumeration date
11/27/2006
Last updated
12/06/2023
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