Provider Demographics
NPI:1053400416
Name:GRAFTON DERMATOLOGY AND COSMETIC SURGERY
Entity type:Organization
Organization Name:GRAFTON DERMATOLOGY AND COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:HOYE
Authorized Official - Last Name:GRAFTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-876-5000
Mailing Address - Street 1:327 BAYOU GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1434
Mailing Address - Country:US
Mailing Address - Phone:985-876-5000
Mailing Address - Fax:985-876-5280
Practice Address - Street 1:327 BAYOU GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1434
Practice Address - Country:US
Practice Address - Phone:985-876-5000
Practice Address - Fax:985-876-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022623174400000X
LA023735174400000X
LAA10451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441953Medicaid
LA4359897160OtherB;UE CROSS DR. CHARBONNET
LA435061414AOtherBLUE CROSS
LA4359897160OtherB;UE CROSS DR. CHARBONNET
LA1441953Medicaid
LAG53549Medicare UPIN