Organization
E. M. DIMITRI, D.O. PMC
Active
Other names
Dimitri Dermatology, Mississippi Skin and Psoriasis Center
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN R DRAKE (GENERAL MANAGER)
(504) 229-7451
Entity
Organization
Contact information
Practice address
2104 GAUSE BLVD W, SUITE A, SLIDELL, LA 70460-4130
(985) 643-4575
(985) 643-4513
Mailing address
2104 GAUSE BLVD W, SUITE A, SLIDELL, LA 70460-4130
(985) 643-4512
(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
—
07454201
—
MS
05
—
2109511
—
LA
Enumeration date
10/02/2007
Last updated
01/31/2024
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