Individual
BETHANEY JUNE VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Contact information
Practice address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-3330
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-3330
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PGY.1.TUL-IM
LA
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
MD.205613
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01988200
—
MS
05
—
1002569
—
LA
Enumeration date
12/13/2007
Last updated
11/05/2012
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