Basic Information
| Provider Information | |||||||||
| NPI: | 1821285438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TULANE DERMATOLOGY AFFILIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 42ND AVENUE | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288648049 | ||||||||
| FaxNumber: | 2288647655 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 42ND AVENUE | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288648049 | ||||||||
| FaxNumber: | 2288647655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 12/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | DEPREO | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2288648049 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.