OrganizationActive
Integrated Dermatology of Ponchatoula, LLC
NPI 1508234600 · Dermatology Physician · Ponchatoula, LA
Provider details
- NPI number
- 1508234600
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jeffrey Queen, Manager(561) 314-2000
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
180 N 5th St
Ponchatoula, LA 70454-2532
Phone: (985) 370-7546
Approximate (ZIP-level) locationGet directions
Mailing address
4700 Exchange Ct Ste 110
Boca Raton, FL 33431-4450
Registry dates
- Enumerated
- 2015-09-04
- Last updated
- 2019-05-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.